February 5, 2019

Zuckerberg San Francisco General Hospital will suspend 'surprise' bills for 90 days

Daily Briefing

    Following widespread media coverage of "surprise" medical bills at Zuckerberg San Francisco General Hospital (ZSFG), the hospital on Friday announced that it would suspend balance billing for 90 days in order to determine a new approach.

    What patients want along their financial journey

    ZSFG's past billing practices raised a backlash

    ZSFG, a public hospital and the area's only top-tier trauma center, currently does not contract with any private insurance plans—although it does bill insurance companies as an out-of-network provider "as a courtesy" to patients, the hospital says in its forms. As a result, many patients wind up facing "balance bills" for amounts that their insurers decline to cover.

    ZSFG's billing practice came under fire last month after Vox profiled Nina Dang, a ZSFG ED patient who received a $20,243.71 bill after a bike accident that left her with a broken arm.

    After the story was published, ZSFG lowered Dang's bill to her insurer's $200 copayment.

    But Dang is far from the only insured patient to have faced a surprise bill from ZSFG. According to the San Francisco Chronicle, 300 patients last year faced unexpectedly high bills. Approximately 6% of patients who are treated at the hospital are privately insured, according to a release from the mayor's office. California law does not allow hospitals to balance bill HMO patients, though the protection does not extend to PPO patients.

    In the original Vox piece, Brent Andrew, a spokesperson for ZSFG, emphasized that the hospital focuses on serving patients with public insurance, which requires charging privately insured patients more to offset the costs. "Our mission is to serve people who are underserved because of their financial needs," he said. "We have to be attuned to that population."

    ZSFG hits 'pause' for 90 days

    On Friday, ZSFG and San Francisco Department of Public Health, which operates the hospital, announced that the hospital will halt balance billing for 90 days, during which time the hospital and health department will develop a new billing policy for the hospital that will seek to protect privately insured patients from unexpected, uncovered medical bills, the department said in a statement.

    The halt is not retroactive—meaning that patients who are currently facing or disputing high ED bills from ZSFG will not have them waived. As for patients who receive care from ZSFG during the 90-day suspension period, ZSFG "will hold [their] bills and then follow the new [long-term] policy once it is in place," according to Andrew.

    It is unclear what will happen with these patients' bills after the 90-day policy development period concludes.

    While the hospital and health department develop a plan, it has started pursuing contracts with private insurance companies, the San Francisco Chronicle reports.  CEO Susan Ehrlich did not specify, however, which private insurers or how many it is pursuing.

    ZSFG also will consider several other changes to protect patients from high bills. According to Ehrlich, the hospital consider changing its income requirements for charity care, establishing an out-of-pocket maximum for patients, doing a better job at informing patients when they qualify for financial assistance, and studying other Bay Area hospitals' billing practices.

    The San Francisco Board of Supervisors, which oversees the hospital, plans to hold a hearing Feb. 21 to discuss whether the new policies will be applied retroactively, as well as to consider other billing practices.

    Ehrlich said, "Anybody who was subject to these policies previously, that's something we have to work with our city partners and city policymakers on." She added, "We want to make sure we do a better job in the future of taking care of people's financial health as well as their physical health" (Kliff, Vox, 2/1; Gooch, Becker's Hospital CFO Report, 2/1; Knight, San Francisco Chronicle, 2/1; Office of the Mayor release, 2/1).

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