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Explanation of Patient Responsibility for Payment of Medical Treatment

November 10, 2022

As medical costs and inflation are on the rise, more and more people choose High-Deductible Health Plans (HDHPs). While those who have an HDHP may pay less for health care insurance on a monthly basis, when it comes to a medical emergency they end up having to pay out of pocket. If the patient doesn’t have the money to pay their medical bills, the health care provider suffers from a lack of payment for services provided.

What Is Patient Responsibility for Payment of Medical Treatment?

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Image via Flickr by Grant Source

When a patient has health insurance, their policy states how much the insurance provider will pay to reimburse the health care provider and what percentage the patient is responsible for. Uninsured patients ultimately must pay 100% of the medical bill and must find a way to pay for their treatment and services. Physicians and hospitals may have to wait to get reimbursed while the patient finds a way to pay, prolonging payment to the health care provider. Most hospitals and health care providers can direct patients struggling to pay their medical bills to resources or organizations that can help.

The Affordable Care Act

In 2010, the federal government enacted the Affordable Care Act (ACA) health care reform law to address health care coverage and costs. This two-part law, collectively called the Patient Protection and Affordable Care Act, makes health care more accessible and affordable to households that meet the financial requirements. People who are eligible for the ACA will get affordable insurance, and health care providers and hospitals will receive payment for medical services provided as stipulated in the insurance policy.

In order to receive payment from the ACA program, the physician, health care provider, or hospital must have high quality-of-care and pay-for-performance scores. The higher the scores and the more cost-effective the provider is, the more reimbursement they’ll potentially receive from ACA health care insurance providers.

Financial Assistance for Medical Emergencies and Debt

According to the Patient Advocate Foundation, if an uninsured patient goes to the emergency room for medical assistance, the hospital must provide aid if the emergency falls under these federal guidelines:

  • A severe or life-threatening situation.
  • If bodily functions or organs are seriously impaired.
  • A pregnant woman’s delivery is imminent.

After treatment, the patient is still responsible for the emergency room and hospital stay bill. Uninsured or underinsured people should seek financial assistance to help pay for their medical debt.

Some hospitals may offer patients some type of financial assistance until the patient can get coverage under the ACA or Medicaid program. In addition, patients struggling to pay for medical treatment can reach out to organizations and charities that’ll help pay for medical bills. Most people want to pay for their medical treatment, and through the ACA and other charities and organizations, they can find financial help to pay their debts.We can help clarify these often confusing payment issues for someone uninsured or underinsured, and help with billing issues if needed. We are experts at negotiating payment terms that work for both patient and health system

Affiliations Audits & Achievements

  • HFMA: Healthcare, financial, management, association
  • AAHAM: American Association of Healthcare Administrative Management
  • ACA International

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