Summa Health Changes Billing Policy for Uninsured & Out-of-Network Patients Amidst Coverage Concerns
Akron, OH – Summa Health is now requiring upfront payment or payment arrangements from patients who are uninsured or whose insurance is out-of-network, a policy shift the health system says is designed to protect both patients and the institution as healthcare costs and potential coverage losses rise. The change, first reported by News 5 Cleveland, comes as concerns mount over potential declines in insurance coverage due to recent federal legislation.
The new policy requires patients without insurance or with out-of-network plans to discuss payment options before receiving non-emergency care. Summa Health spokesperson Maureen Nagg explained in a statement that the system dedicates “significant resources” to securing payment from insurance providers, but “frequently enough that effort results in little, to no, payment.The patient is then responsible for any remaining bill, which can be considerable.” She emphasized the policy aims to protect patients from unexpectedly large bills.
The move is not unexpected, according to dr. Robert Silvers, a professor of healthcare finance at Case Western Reserve University’s Weatherhead School of management. “This policy is in place not only to protect Summa Health but also the patient,” Nagg stated. Dr. Silvers anticipates other healthcare systems will follow suit, notably in light of a recently passed congressional spending bill.
Analysis from the Congressional Budget Office (CBO) projects that up to 16 million Americans could lose health insurance coverage due to cuts to Medicaid and changes to the Affordable Care Act (ACA) marketplace.”The concern I think everybody has now is its going to get worse,” Dr. silvers said. “With medicaid cutbacks, there’s just no question. And with eligibility and the cost of care, with the affordable care plans, with Obamacare going up dramatically, hospitals are basically scared. And for good reason.”
Summa Health maintains the policy change was not prompted by federal cuts or its recent acquisition. In June, the Ohio Attorney General approved the nonprofit health system’s acquisition by HATCo, a private equity firm specializing in healthcare venture capital.The health system stated it has “strong working relationships with more than 25 contracted health plans throughout the region” and is continually engaged in contract negotiations.
The policy change has raised concerns among patients. john Somerick, a Summa Health patient, told news 5, “I love this hospital, but I’d have to go wherever my insurance would pay for it.”
Context: The Growing Financial Strain on Healthcare Systems
This development highlights a long-standing challenge for hospitals: uncompensated care. Hospitals are legally obligated to provide emergency care to all,regardless of ability to pay. However, recovering costs from uninsured patients or navigating complex out-of-network billing can be extremely tough.The ACA significantly reduced the number of uninsured Americans,but rising premiums and limited provider networks have created affordability issues for many. Recent legislative changes threaten to reverse those gains, possibly increasing the burden of uncompensated care on hospitals.
The increasing role of private equity in healthcare is also a key factor. Firms like HATCo often prioritize financial returns, which can lead to cost-cutting measures and a focus on profitability. This acquisition, and similar trends nationwide, are raising questions about the future of non-profit healthcare and access to care for vulnerable populations.
RELATED: Non-profit Summa Health to be acquired by health care venture capital firm