(Kevin N. Hume/S.F. Examiner)

SF General to set new limits on out-of-pocket payments by patients

Policies changing after reporting showed privately insured often left with unexpectedly large bills

Following a public outcry over practices that have left some privately insured patients with unexpectedly large bills, Zuckerberg San Francisco General Hospital announced changes to its billing policies Tuesday that include new limits on out-of-pocket payments for patients.

The hospital, which is managed by San Francisco’s Department of Public Health, came under fire earlier this year when news reports revealed that the hospital is out of network with all private insurance plans, leaving insured patients with exorbitant debt due to “surprise bills.”

The proposed policy changes include no longer “billing private insurance patients any more than they would have paid out-of-pocket for the same care at in-network facilities,” according to a statement released by DPH on Tuesday.

The department announced that it will set an out-of-pocket maximum for patients “of all income levels,” ranging from $0 for those earning up to 138 percent of the federal poverty level to a maximum of $4,800 for those “above 1,000 percent of the federal poverty level.”

Under federal guidelines, an individual earning at 138 percent of the poverty level is making about $16,753, while a family of four is earning about $34,638. At 1,000 percent of the federal poverty level, an individual is earning above $121,400 and a family of four is earning above $251,400.

The proposed changes also call on DPH to expand the availability of bill reductions for patients by increasing the eligibility for income-based sliding scale and charity care programs. For the former, which serves only San Francisco residents, assets tests will be eliminated and the share of cost reduced to $0 for incomes of up to 138 percent of the federal poverty level.

For the Charity Care program, the department plans to expand eligibility from 350 percent of the federal poverty level to 500 percent.

Under the direction of Mayor London Breed and Supervisor Aaron Peskin, DPH and hospital leaders were given 90 days to come up with a new plan on how to bill insured patients, who make up just 6 percent of the public hospital’s overall clientele. The practice of billing insured patients the full balance of what their insurers won’t cover was halted on Feb. 1, 2019 and will not continue, according to DPH officials.

The department was also directed to study ZSFG rates in comparison to other hospitals, conduct financial analysis of the proposed changes, support legislative policy solutions and improve patient communications.

“Above all, we care about people,” said DPH Director Dr. Grant Colfax. “Although the vast majority of our patients do not have private insurance, every patient matters equally. We believe that the insurance industry should pay its fair share for the care patients deserve and we provide, and that neither patients, nor taxpayers should be made to pick up the slack.”

According to DPH, the proposed changes will be implemented in the coming months, and the department is expected to present a progress report to the Health Commission this summer.


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