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Elliot Hospital will require $150 upfront fee for urgent care

New Hampshire Union Leader

December 02. 2012 7:40PM

MANCHESTER - Elliot Hospital will require an upfront $150 fee for uninsured patients seeking treatment at its urgent care locations starting Tuesday, a move hospital officials said is needed to address an unsustainable level of unpaid care the organization provides.

Insured patients will have to satisfy co-payments before they receive treatment, said Rachel Verville, chief financial officer at the Elliot.

The announcement comes about seven months after the Elliot said it was considering such a fee at its two urgent care centers, which are located in Londonderry and at the Elliot at River's Edge ambulatory care center in Manchester. Verville said urgent care centers with other organizations have similar policies.

"We find we're a bit behind the curve on this," Verville said. About one in 10 of the Londonderry urgent care patients are uninsured; 18 percent at River's Edge are uninsured, the Elliot said.

Hospitals have traditionally provided free care to the indigent, in part because of Medicaid payments they received for doing so. But New Hampshire hospitals lost their Medicaid disproportionate share funding in 2011, prompting layoffs and lawsuits over the New Hampshire tax and reimbursement policy when it comes to Medicaid.

The Elliot alone lost $16.8 million because of New Hampshire changes to the Medicaid program last year.

A Catholic Medical Center official was surprised to hear about Elliot's new policy.

CMC, which operates an urgent care center on River Road in Bedford, asks its uninsured patients for payment at the time of service but does not have a policy to collect a minimum deposit, said Alex Walker, general counsel for the hospital.

"We don't send people away," he said. "We don't anticipate making any changes to our current arrangements," Walker said.

The Dartmouth-Hitchcock Clinic urgent care center in Manchester is limited to patients, but an uninsured person who wanted care would be registered as a patient, go through the financial screening process and then receive care, said Dartmouth-Hitchcock spokesman Rick Adams.

"We don't deny patients care," he said.

For Elliot patients who cannot pay $150, financial counselors will inform them of other options, such as the Manchester Community Health Center, other urgent care centers or emergency rooms, where hospitals are required by law to stabilize and care for a patient despite their ability to pay, Verville said.

Verville said Elliot counselors will be on hand to help patients begin the application process for free or reduced-cost charity care, but that process can take weeks, and a patient will still have to pay $150 before receiving treatment. That money would be reimbursed if the patient were later deemed eligible for charity care.

Charity care is available on a sliding scale based on income and family size. A family of four can receive free care if their family income is $44,700 or less. Discounted care is available for the same-sized family with an income up to $89,400. Patients who qualify for charity care need only pay a $10 co-pay before receiving urgent care treatment.

Verville said the Elliot projects $72 million in uncompensated care for its current, 2013 budget year, up from $57 million in 2011. The number entails care throughout the Elliot Health System, which includes the urgent care centers, hospitals and other services.

"We're seeing a sharply rising curve that really gets much steeper starting in 2011," Verville said. She said the level is unsustainable.

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