Vox.com: Zuckerberg hospital suspends surprise ER billing tactics after Vox story

Officials at Zuckerberg San Francisco General Hospital say they intend to change their longstanding policy of being out-of-network with all private insurance, a billing practice that has left insured patients in debt for tens of thousands of dollars.

In January, a Vox story drew nationwide attention to the aggressive tactics.

The problem is acute for patients like Nina Dang, 24, who make unexpected trips to the hospital’s emergency room, the largest in San Francisco. An ambulance took Dang to the trauma center after a bike accident last April. She is insured by a Blue Cross plan, but she didn’t know that the ER does not accept insurance. She received a bill for $20,243. The hospital has since reduced Dang’s bill to $200, the copay listed on her insurance card, after our story about her experience.

Now the hospital is taking steps to change its billing. It will temporarily suspend a practice known as “balance billing,” when a hospital sends a patient a bill for the balance that an insurer won’t pay.

statement from the Department of Public Health, which runs the hospital, says it use the next 90 days to create a new billing policy that doesn’t leave patients with ruinous medical bills.

“We need to look hard at our current billing practices, and until we come up with a plan that works for patients, we will not continue the practice of balance billing,” San Francisco Mayor London Breed said in a statement. “In an emergency, people’s focus should be on getting help quickly, not on what hospital they should go to. Private insurance companies also need to be held accountable to actually pay for the healthcare for anyone they cover.”

Heather Knight with the San Francisco Chronicle first reported the development on Friday. She also spoke with Zuckerberg General’s chief executive, who said the hospital is taking steps to begin accepting private insurance and to lower costs for some patients:

As it comes up with a plan, the hospital has begun pursuing contracts with private insurance companies, though CEO Susan Ehrlich wouldn’t say which ones or how many. She said S.F. General will also do a better job informing patients they may qualify for financial assistance, look at expanding the income requirements to qualify for charity care, set an out-of-pocket maximum for patients, and study how other Bay Area hospitals handle their billing.

As Knight notes, the policy change does not affect patients who are currently fighting bills from Zuckerberg San Francisco General Hospital, including a man she interviewed who owes the hospital more than $92,000 for an emergency appendectomy.

Nor is it clear how patients who receive care during this temporary suspension will be billed when the window ends.

The San Francisco Board of Supervisors, which oversees the hospital, plans to hold a hearing on February 21 to examine the hospital’s billing practices.

Prior to Vox’s reporting, Zuckerberg General had a longstanding policy of remaining out of network with all private insurers. Vox reviewed five patient bills from the hospital’s emergency room, in consultation with medical billing experts, and found that this practice can cost privately insured patients tens of thousands of dollars for care that would likely cost them significantly less at other hospitals.

Most big hospital ERs negotiate prices for care with major health insurance providers and are considered “in network.” Zuckerberg General had not done that bargaining with private plans, making it “out of network.” That leaves many insured patients footing big bills.

The bills were all submitted by patients to Vox’s emergency room billing database, which served as the basis for a year-long investigation into ER billing practices. Vox has collected more than 1,900 bills from all 50 states and the District of Columbia.