More and more, American hospitals are demanding deposits from foreign patients admitted for emergency medical services, even when they have valid travel insurance. The practice is particularly evident in hotspot international tourism destinations—Las Vegas being a prime example.
I have recently heard of several cases where patients’ spouses were virtually intimidated into signing credit card approvals for thousands of dollars just to make sure that if their insurer balked at the bill—or worse, denied coverage altogether—the hospital would get some money.
Despite a federal law that forbids hospitals from denying emergency care to anyone who needs it, whether they have health insurance or not, there is no law prohibiting hospitals from demanding deposits or promissory notes for services rendered so long as they fulfill their obligations to provide emergency care.
If you’re faced with such a demand, first try to sort it out with your insurer and put them in touch with the hospital administration. If you still need to pay up, keep your payment as low as you can and make sure you have a clear record to present to your insurer when the final settlement is made. You want to make sure you get your money back.
The hospital’s people may tell you the emergency is likely to cost some $30,000, but the truth is the insurer would pay only a fraction of that in any case, so don’t hand over that amount.
But why, when you have insurance, do hospitals persist in demanding payment from you? Because too often, if you are a foreign patient, they can’t immediately verify your insurance or what it covers and/or excludes. They don’t know if your insurer will pay the full bill, or only 30 cents on the dollar—and they don’t know if the insurer might even deny your coverage totally (for lying on your application, hiding a pre-existing condition, not telling the complete truth about your health, and so on). And if the insurer denies your coverage, hospitals have no one to go to for payment but you. And they will.
American hospitals have very complicated methods of charging insurers for services rendered. Most will give substantial discounts to those insurers who can steer big numbers of patients their way. Domestic American insurers can do that. But foreign insurers can’t. They don’t have the numbers. Yet many foreign insurers try to get the same discounts that domestic US insurers do—and hospitals say “no way.”
As a result, many American hospitals, particularly in high-density tourism areas, now routinely hand over any foreign hospital bill to professional collectors and leave it to them to get as much as they can using any and all of the tactics collectors are famous for.
Your best protection against this kind of intimidation is to have an appropriate insurance card, with your insurer’s logo and US emergency assistance contact number printed on it, so that hospital accountants can quickly and easily verify authenticity and extent of coverage. Carrying your policy with you can also be a big help.
What you should not do is fail to take insurance documentation with you. Do not travel with only the insurer’s or broker’s telephone number written on a scrap of paper. I know many people who do that, and then they complain when a hospital in effect denies them what amounts to unsecured credit for what could be tens of thousands of dollars for medical services.
Though US hospitals provide a lot of charity care, that’s not what they’re in business for.