HCA announces it will waive trauma fees for the uninsured

Herald/Times Tallahassee BureauApril 11, 2014 

Fees work like a cover charge, come in addition to medical procedures charges

TALLAHASSEE -- Hospital Corporation of America, Florida's largest provider of trauma care, announced this week it will stop charging uninsured patients a special trauma fee that can add $30,000 or more to their bills.

The new policy, announced this week to the News Service of Florida, comes one month after the Tampa Bay Times published the results of a yearlong investigation showing that hospitals across the state were charging huge fees to trauma patients even when they needed little more than first aid.

The fees work like a cover charge and come in addition to charges for medical procedures. The Times found that HCA's fees were by far the highest in Florida, averaging $27,644 in the first half of last year compared to $6,754 at other hospitals in the state.

Even so, waiving the trauma fees for uninsured HCA patients might have little impact. Hospitals generally collect only a portion of what they bill patients. And the amount collected from uninsured patients -- compared to those covered by auto or health insurance policies -- can be tiny.

HCA officials told the Tampa Bay Times last month that their hospitals collect less than $300, on average, from uninsured patients.

After the Times' investigation, the Florida Senate tacked provisions onto one of the bills that would curb the fee and promote pricing transparency. The House is considering doing the same.

The Senate is considering legislation to cap the fee at $15,000 for a year and convene an advisory council to study fees and make long-term recommendations. The House is considering a similar $15,000 cap and would require hospitals post their trauma fee prices inside their trauma centers and on their websites.

HCA officials did not respond to questions from the Herald/Times about its new policy.

It was unclear from HCA's announcement whether the discount will apply to car crash victims whose only coverage is auto insurance or whether it will apply at HCA trauma centers outside Florida.

In 2012, an HCA trauma center in Nevada charged hospitalized patients an average trauma fee of $21,227. And last year in California, one HCA center's price list included trauma fees as high as $30,662.

Pat Palmer, a healthcare consultant who analyzes patient charges for Medical Billing Advocates of America, says HCA's new policy gives her "great concern."

"Why are we discriminating against people that are not uninsured?" she asked.

"There are a lot of under-insured, who have high deductibles, and they're responsible for these amounts."

Since 2012, HCA's Florida trauma centers have charged at least $26 million in trauma fees to more than 900 uninsured patients, according to data reported to the state's Agency for Health Care Administration.

One in six of the HCA patients charged a trauma fee was uninsured.

Meanwhile, HCA has charged at least $70 million in trauma fees to more than 2,400 patients with commercial insurance -- almost half of all patients charged the fee.

It is impossible to know how much uninsured patients actually wound up paying because hospitals are not required to publicly report such numbers.

Tony Carvalho, president of the Safety Net Hospital Alliance, said HCA's move "is nice," but that the company probably was collecting little, if any, money from its uninsured trauma patients.

Speaking for the alliance, which represents Florida trauma centers involved in lawsuits to shut down HCA trauma centers, Carvalho said, "There should be protections from price-gouging for all patients."

HCA attorney Steve Ecenia told the News Service of Florida that the company's new fee waiver for the uninsured is not related to the Tampa Bay Times' reporting, and that company officials had been looking at the issue for "quite a while."

Yet in numerous communications during the Times' yearlong investigation, HCA officials did not mention the potential for waiving trauma response fees for all uninsured patients.

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