UNMH right to ask for surgery down payments

Despite all the hand-wringing from advocates for the poor, there really is no responsible reason why the University of New Mexico Hospital should not require uninsured patients to pay 50 percent in advance for nonemergency surgeries.

Or at least require them to agree to a payment plan, which may not require the 50 percent upfront.

Of course, the key words here are “non-emergency.” Emergency surgery is done when needed regardless of one’s ability to pay.

While community health advocates claim UNMH recently eliminated “affordable” co-pays from its 2015 Patient Payment Policy, UNMH officials say the hospital’s “finance guidelines for surgical cases” issued in May require all patients to receive approval by a UNMH financial consultant before they are scheduled for nonemergency surgery.

UNMH has a good reason for the provision: Insurance companies were refusing to pay for surgeries that had not been pre-approved. And when insurance companies don’t pay, and uninsured patients don’t pay, taxpayers do.

The 50-percent-down payment applies only to surgeries and other procedures “not deemed medically necessary and determined to be purely elective by our medical staff,” UNMH officials said. And a hospital spokesman notes financial consultants can approve a payment agreement instead of requiring the full 50-percent payment up front.

Contrary to some health advocates’ assertions that poor patients are being singled out, note that all nonemergency surgical patients have to go through the same process, even those with the best medical insurance available — for which they pay correspondingly high premiums.

On the flip side of that coin are patients who made the choice to not purchase insurance under the Affordable Care Act, preferring instead to pay the tax penalty for not doing so. Such choices carry implicit risk.

UNMH officials point out the 50-percent-down payment can be deferred if doctors consider the surgery “medically urgent.” And put simply, UHMH will not — and in fact according to law cannot — refuse necessary medical treatment based on a patient’s ability to pay. The required financial screenings help determine what amount, if any, the patient has the ability to pay for a non-emergent surgery. If they determine a patient should be able to pay 50 percent up front, and no other payment plan is appropriate, then they should be required to do so and placed on a post-surgery payment plan that recoups as much for UNMH’s services as is fair and equitable.

Sireeshe Manne, an attorney with the New Mexico Center on Law and Poverty, claims UNMH’s “finance guidelines for surgical cases” require indigent patients “to go through a huge bureaucratic process to get care.” Welcome to health care in the 21st century, where everyone — from the well-insured to the uninsured — goes through a sometimes burdensome process to obtain the medical services they need.

Everyone should be required to pay as much of their medical bills as possible. The financial screening, just like the medical screening that determines what a patient needs to ensure the best health possible, is a reasonable and financially responsible requirement.