Hospitals and Their BUCA Moat Must Go Bye Bye

By Bill Hennessey, M.D.• Chief Innovation & Billing Integrity Officer

Non-profit hospitals have been known to send hate mail to employer groups using reference-based pricing (RBP), meaning a health plan that is not Blue Shield, United, Cigna or Aetna (BUCA). This illegally denies access to care the very working poor entitled to free care under the ACA IRS 501r, dating back to March of 2010.

Non-profit hospitals are asking for a ridiculous sum of money upfront for many who are in RBP plans. Hospitals refuse to pre-authorize, so to speak, for financial assistance, but instead want a patient to get care, and then set up the determination with their subjectivity. While it is legal to be evaluated for financial assistance after care has occurred, and that’s what the hospitals are doing now as their MO, it is also legal and would be good customer service for hospitals to pre-authorize for financial assistance. Thus far, they have all failed to deliver this type of good customer service.

Non-profit hospitals legally cannot blanketly deter or send hate mail to employer groups who have employees that would qualify for financial assistance. This violates their non-profit legal promise to provide free and discounted care to those that qualify in their communities. Turn these hospitals in on IRS form 3949-A and ask to have their non-profit tax status revoked.

And know that CareGuide Advocates is the best way to pay the least for care. We help hospitals honor and fulfill their non-profit obligation to better serve their communities every day. And for the that don’t qualify, our hospital bill negotiation team’s war chest of tools and our team get you the best deal that is second to none. Finally, someone who cares and is on your side!