UNC Health Care to start asking for payments from uninsured

UNC Health Care, suffering from growing losses for uncompensated care, is going to start seeking co-payments from patients qualifying for charity care and requiring deposits from uninsured patients.

Under the new plan, which will go into effect April 20, the hospital system will request from those patients between $20 and $100 for services. Fees vary depending on the type of service and whether the patient is uninsured or qualifies for charity care. The payments will be required at the time of the patient’s visit.


“We have a tidal wave of indigent patients coming to us these days as a result of the economic turmoil and rising unemployment rate in North Carolina,” says CEO Bill Roper. “It’s unsustainable. We can’t continue in this mode for long.”

UNC Health Care is struggling to maintain revenue as it doles out care to those who are unable to pay. In 2004, the cost of the hospital system’s uncompensated care totalled $140 million. This year, it is expected to surpass $270 million. Next year, the projection is for more than $300 million.

Uncompensated care includes charity care for those whose incomes are less than 250 percent of the federal poverty line, uncollected debt, and the difference between what Medicare reimburses the health system and what the procedures cost.

The hospital system has no estimates for how much the new policy will reduce its uncompensated care losses. Hospital spokeswoman Karen McCall says UNC will be monitoring the impact to make sure the plan is working.

Under the plan, non-emergency patients who say they cannot pay will be directed to one of the hospital system’s financial counselors, who will evaluate patients’ ability to pay. Federal law dictates that the hospital treat emergency cases regardless of ability to pay.

The counselors will look to see if the patients qualify for Medicaid, some other benefit – such as workers’ compensation – or charity care. If they are deemed indigent and unable to pay, they will be provided free service, says Roper. If they are able to pay, they will be charged the deposit or copay.

“We believe forthrightly in asking people to pay for care if they are able to,” Roper says. “I think the average North Carolinian will agree with that.”

Those without insurance will be refunded part of their deposit should treatment cost less, though Roper says most treatments cost more than the deposits they are charging.

The policy applies only to UNC Hospitals and its affiliated physicians. Rex Healthcare is not included.

UNC Hospitals has received criticism in the past for its efforts to collect payment from patients. In 2007, UNC Hospitals was criticized for overly aggressive bill collection practices. In one instance, the hospital placed a $185,300 lien on a patient’s home. Bowing to the criticism, the hospital dropped the lien and wrote off the debt.

Roper says the new plan is not as aggressive and keeps in line with the hospital’s mission to provide care to all North Carolinians.

source