By Bill Rusteberg
UMC Health System in Lubbock, Texas has 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 she needs it, no matter where she needs it.
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 plays the patient against her employer, hoping the patient will side with hospital by petitioning the employer’s health plan pay the hospital’s 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 different took place. Something magical 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.
The plan saves money, the patient gets the care she needs at no cost to her she receives a portion of plan savings, all made possible by monies UMC lost in revenue that they would have been wise to accept.
When providers don’t want to play ball, there is always someone, somewhere who will.
