UMC Health System in Lubbock, Texas recently refused to accept an assignment of benefits offered by a prospective patient in need of care because the hospital wanted a higher reimbursement than what the hospital accepts from Medicare, the largest government health plan universally accepted throughout the United States.
UMC is a tax exempt nonprofit hospital owned by the taxpayers of Lubbock County governed by the Lubbock County Commissioners Court.
The patient is a public sector employee whose employer’s health plan is funded in large part by local taxpayers. As is the case with most of us, this patient doesn’t have the wherewithal to pay for the care she needs. Instead, she relies on her government sponsored health plan to fund the care she needs when needs arise.
In this case the patient’s unfulfilled and critical medical need creates a financial dynamic played out repeatedly throughout the medical industrial complex. She became a pawn, a bargaining chip wedged between UMC and her employer’s health plan. The strategy pits the patient against her employer, hoping the patient will side with hospital by petitioning the employer’s health plan pay the hospital’s inflated demands. This is quite an effective strategy as employers want to do everything they can to see their employees get the care they need, anytime and anywhere at any cost.
Not in this case. Something magnificent happened. The patient and her employer banded together and gave the proverbial finger to UMC.
The plan offered and the patient agreed to travel to a surgical center for her procedure at no out of pocket expense to her. The savings to the plan was shared with the patient in the form of a shared saving cash payment in the amount of $5,000 proving it pays to get sick when hospitals demand more than an arm and a leg.
The plan saves money, the patient gets the care she needs at no cost to her and she receives a portion of plan savings, all made possible by monies UMC lost in revenue that they would have been wise to accept. UMC’s poor business decision was a gift to both plan and plan member.
When providers don’t play ball, there is always someone, somewhere who will.
Let me see if I can get this right. A hospital that doesn’t pay taxes governed by a tax supported county government that doesn’t pay taxes refuses to provide care to a tax paying plan member of a local tax supported government health plan that doesn’t pay taxes unless paid more than the largest government health plan in the country that doesn’t pay taxes. Taxing entities are taxing themselves without knowing it in the form of higher hospital costs while clueless plan members are silently double taxed in the form of higher insurance premiums.
