Shriners Hospitals for Children is changing

[CPT Tripss]

It wouldn't surprise me if they do. People seek care at Shriners, not just because it was "free" but because they have skills that other facilities may not have. If they accept insurance they have no choice but to collect the copays and deductibles, otherwise, it is considered insurance fraud.

That would be one way to satisfy that. Also, hospitals can write off copays and deductibles if by being charitable, if the patients demonstrate need. But to just not bother to collect, bill or attempt to get them paid is considered fraud.

I don't think you are correct. Can you cite some law? Considering that copay and deductible go to the provider - the Shriner's Hospital, using donations for this purpose seems futile.

The changes in how these charities bill may have more to do with Medicaid . . . they only pay providers up to the lowest fee the that the provider charges, which is zero when free care is provided to all.

 

[Judy from Boise]

I think it is accurate. We have to bill for co-pays and deductables......after the family says there can't afford it we ca write it off. To write it off prior to billing is considered fraud ( enticement) by the Feds.

 

[Rabscuttle]

I don't think you are correct. Can you cite some law? Considering that copay and deductible go to the provider - the Shriner's Hospital, using donations for this purpose seems futile.

The changes in how these charities bill may have more to do with Medicaid . . . they only pay providers up to the lowest fee the that the provider charges, which is zero when free care is provided to all.

Besides the fact that I know it to be true, I found this with a quick google search.

It falls under three separate acts: HIPAA, Stark I and Stark II regarding providers of medical services and billing practices.

From LSU's Law Center:



Waiving Co-Pays

The most common ways physicians reduce the cost of care for patients are waiving the co-pay ("insurance only") and giving the patient a discount on the care. In most situations, both private insurers and the federal government ban waiving the co-pay. (Medicare has some provisions allowing the co-pay to be waived for documented indigency.) They do this because the co-pay is meant to discourage casual trips to the physician. The theory is that making the patient share the cost of treatment will make the patient a more sophisticated health care consumer.



Discounts

A discount is a reduction in the normal charge based on a specific amount of money or a percentage of the charge. Just as the hardware store can give you $5 off on all tools or a 10% discount on your total purchase, a physician may take $5 off or 10% off of the bill for an office visit or a surgery. However, there are things that the physician must beware of in doing this. The discount must apply to the total bill, not just the part that is paid by the patient. If the patient owes a 20% co-pay on a $25 charge ($5) and you are giving a discount of $5 then the patient pays $4 and the insurance company pays $16. If the patient owes a $5 co-pay regardless of the amount of the charge then the patient must pay $5 and the insurance company pays $15. In this situation, the discount would only benefit the insurance company.

http://community.lawyers.com/forums/t/102676.aspx?PageIndex=2

 

[Lisa loves Pooh]

It is unfortunate that they have to change their way of doing things.

I was wondering and thought St. Jude's was similar and it seems based on the above post that they are.

I don't understand why a hospital wouldn't. But if Shriner's could get this far without doing that, that is just a testament to their past fundraising I would guess.

 

[C.Ann]

St Judd's does bill insurance. I think it would be foolish not to:


Payment and Charges

St. Jude provides medical care to its patients at no cost to the patient or the patient’s family. If you have insurance, St. Jude will bill that insurance company or other third-party payers for medical services provided by the hospital. You are required to help St. Jude comply with the insurance company's needs. Even so, you will pay no co-pays or deductibles. ALSAC will cover all direct costs of St. Jude medical care not covered by insurance or third-party payers. ALSAC was founded for the purpose of supporting St. Jude. If you do not have insurance, you will be referred to our MedAssist office to see if we can find insurance coverage for your child. If you have questions about payment, charges, or insurance, talk with a staff mmember in Patient Registration.

I didn't say they didn't - I said I wasn't aware of it.. Not sure what difference it is (or was) supposed to make..

It wouldn't have changed my donations over the past 39 years - nor will it change my future donations as long as I'm alive..

 

[Lisa loves Pooh]

I didn't say they didn't - I said I wasn't aware of it.. Not sure what difference it is (or was) supposed to make..

It wouldn't have changed my donations over the past 39 years - nor will it change my future donations as long as I'm alive..

I don't think this makes it a sad thing for Shriner's to have to adopt that model.

It will help stretch your donations further.

Always look at the bright side.

 

[DMRick]

I think think that is the same model that St. Jude's uses.

LOL..I don't know why you posted the confused face and quoted me. I didn't say anything would have changed about your donations. Good for you that you donate to St Judd's. I was just commenting on what SueM said..verifying it I guess, that she's right, they do bill the insurance (I was commenting on the above quote). I'm not sure how what I said had to do with your donations and if you'll continue or not.

I didn't say they didn't - I said I wasn't aware of it.. Not sure what difference it is (or was) supposed to make..

It wouldn't have changed my donations over the past 39 years - nor will it change my future donations as long as I'm alive..

 

[C.Ann]

I don't think this makes it a sad thing for Shriner's to have to adopt that model.

It will help stretch your donations further.

Always look at the bright side.

Neither do I.. As long as patients are being treated - with co-pays, without co-pays, with billing, without billing, without having a red cent - the important part is that no one is turned away.. Which is exactly why the model they have adopted is irrelevant to me..

The "bright side" is that everyone receives whatever treatment they need - regardless - the same "bright side" I have been looking at for 39 years now..

 

[happygirl]

Neither do I.. As long as patients are being treated - with co-pays, without co-pays, with billing, without billing, without having a red cent - the important part is that no one is turned away.. Which is exactly why the model they have adopted is irrelevant to me..

The "bright side" is that everyone receives whatever treatment they need - regardless - the same "bright side" I have been looking at for 39 years now..

To bad there not a hospital like that for adults

 

[Bluetickmom]

Neither do I.. As long as patients are being treated - with co-pays, without co-pays, with billing, without billing, without having a red cent - the important part is that no one is turned away.. Which is exactly why the model they have adopted is irrelevant to me..

The "bright side" is that everyone receives whatever treatment they need - regardless - the same "bright side" I have been looking at for 39 years now..

I have to clear up a misconception that St. Jude will accept any child with cancer. This is not correct. To receive treatment there you need to be accepted into a clinical study, or have some special circumstance.

St. Jude does in fact turn many, many children down who try to seek treatment there.

 

[PrincessSuzanne]

St Judd's does bill insurance. I think it would be foolish not to:


Payment and Charges

St. Jude provides medical care to its patients at no cost to the patient or the patient’s family. If you have insurance, St. Jude will bill that insurance company or other third-party payers for medical services provided by the hospital. You are required to help St. Jude comply with the insurance company's needs. Even so, you will pay no co-pays or deductibles. ALSAC will cover all direct costs of St. Jude medical care not covered by insurance or third-party payers. ALSAC was founded for the purpose of supporting St. Jude. If you do not have insurance, you will be referred to our MedAssist office to see if we can find insurance coverage for your child. If you have questions about payment, charges, or insurance, talk with a staff mmember in Patient Registration.

Medassist is the company I currently work for (and have for 7 1/2 years), although we now go by Firstsource. We assist patients in obtaining Medicaid or other resources like SSI/Disability. I didn't know if we still had a rep there or not, guess we do.

But prior to working with this company I knew St. Judes filed insurance if you had it, because there is a young lady in our community that was treated there when she was very young, and they would do local fund raisers and still do and would talk about the fact that they took, I believe all insurance, but if they didn't pay or you had no money, you wouldn't be turned away.

We still have a yearly Shriner's Circus and it does really well, being that we are a large military town.

 

[carj]

I went to a hospital like this myself when I was 2-18 in Texas for scoliosis. I was placed in multiple types of braces and then eventually had surgery once I turned 10 and then continued to see the doctors there until I turned 18 and are no longer eligible. It was a childrens hospital that you had to be referred to by your doctor and it was completely free, everything was taken care of by donations, however this particular hospital is not affiliated w/ Shriners childrens hospitals. Although my parents had insurance, they were never even asked to show an insurance card from what they told me. My parents told me they asked how much the surgery cost and all they were told is "it is well over $100,000...but its nothing you need to worry about".

I just pulled up the hospitals website and they still have the same practices. No cost of any kind to the families.

Was it Texas Scottish Rite? My son has been a patient there since he was 6 days old. We went for a visit Friday and they collected insurance information. They told us that they would be begin billing at some time in the near future.

I know that someone else asked if many children who were patients at Shriner's had insurance. I can only speak for our experience at Scottish Rite, which is also supported by the masons. The answer is YES!! We have insurance, and were referred by his pediatrician while still in the hospital.

We went to several other doctors to get second, third, fourth opinions. All of them not only recommended the same treatment, they recommended that Scottish Rite treat him. We are in the Dallas area also, so it isn't a small town. When you are dealing with a rare condition, you go where the experts are.

I have no problem paying co-pays etc... because the quality of care that he recieves is phenomenal. He is 10 years old now and I will say that several years ago, those co-pays, deductibles, etc... would have been pretty painful.

My bigger concern with this new policy is that our insurance has limitations. Our insurance will only cover a new prosthesis every 24 months. My son is on his 8th leg in 10 years. They do everything possible to extend the life of the limb, but eventually, it is just outgrown. I do have some fear that by accepting insurance, they will have to follow the insurance limitations. Hopefully, they will find a way to make it work. Kids grow and prosthetics don't!

 

[Rabscuttle]

I have to clear up a misconception that St. Jude will accept any child with cancer. This is not correct. To receive treatment there you need to be accepted into a clinical study, or have some special circumstance.

St. Jude does in fact turn many, many children down who try to seek treatment there.

That certainly makes sense because clinical studies are often funded by a variety of means and that would cover the cost of hospitalization for many children. Patients that are entered into clinical trials very often do not have to pay for their very expensive drugs because they are in the trial or exploratory process for established drugs persuing (sp) different protocol.

 

[C.Ann]

I have to clear up a misconception that St. Jude will accept any child with cancer. This is not correct. To receive treatment there you need to be accepted into a clinical study, or have some special circumstance.

St. Jude does in fact turn many, many children down who try to seek treatment there.

I was aware of that - as someone who became personally involved with St. Jude 39 years ago - but it didn't occur to me that many people aren't familiar with the full scope of their services; research; clinical studies; etc..

I should have said any child who meets their criteria will not be turned away - based on inability to pay.. My DD did not meet the criteria (and I thank God every day for that) but if she had, the services would have been available to her.. Back then our financial circumstances (thanks to my 1st husband's very poor choices and continually being laid off) would have put us in the category of not having the ability to pay - due to no hospitalization and his reckless spending on drinking & gambling.. (I ended up divorcing him when she was two..)

It's wonderful that such a place exists - as well as Shriners - or many children would either die or have to go without medical treatments.. This is why I will continue to support St. Jude's for the rest of my life.. Nothing against Shriners - I just came way too close to needing St. Jude's so it will always be first on my list of charities..

 

[happygirl]

I have to clear up a misconception that St. Jude will accept any child with cancer. This is not correct. To receive treatment there you need to be accepted into a clinical study, or have some special circumstance.

St. Jude does in fact turn many, many children down who try to seek treatment there.

Read more.

Our unique mission


St. Jude is the only pediatric cancer research center where families never pay for treatment not covered by insurance. No child is ever denied treatment because of the family’s inability to pay. This is what there website said. So they turn away child, after the claim not to?

 

[DMRick]

I didn't think she was saying they were turned away for the inability to pay. She said,

To receive treatment there you need to be accepted into a clinical study, or have some special circumstance.

So even if you can pay, you may not be accepted.

Read more.

Our unique mission


St. Jude is the only pediatric cancer research center where families never pay for treatment not covered by insurance. No child is ever denied treatment because of the family’s inability to pay. This is what there website said. So they turn away child, after the claim not to?

 

[happygirl]

I didn't think she was saying they were turned away for the inability to pay. She said, So even if you can pay, you may not be accepted.

So what if you don't get into a program?

 

[tvguy]

I have no problem with them billing insurance companies, I would think it allows them to free up money to treat more patients.

But in the back of my mind I do wonder if it also is part of their planning to prepare for the National Healthcare law to go into effect. As the law is currently written, there will be no uninsured patients in the future (assuming the law isn't changed or tossed out by the Supreme Court).

 

[CPT Tripss]

In rereading some of the discussion, my concern about labelling patient friendly billing practices "fraud" centers around the difference between billing for co-pay and deductibles and actually collecting them. If the charity hospital writes unpaid bills off as "bad debt" rather than aggressively pursuing payment is that fraud?

 

[Rabscuttle]

So what if you don't get into a program?

There are other fine state of the art hospitals that treat with established protocols outside of clinical trials.

In rereading some of the discussion, my concern about labelling patient friendly billing practices "fraud" centers around the difference between billing for co-pay and deductibles and actually collecting them. If the charity hospital writes unpaid bills off as "bad debt" rather than aggressively pursuing payment is that fraud?

The charity hospital only has to require that the patient establish need for assistance but it is a process that must be complied with, not simply writing it off as uncollectable.