ROCHESTER, N.Y. – Rochester Regional Health is changing its policy on non-emergency, outpatient surgeries. According to an internal staff email obtained by News10NBC, patients will have to pay 100% of their share before the surgery starting January 2, 2025.
The policy has been in place at Unity Hospital for five years, but it will now extend to RGH, Newark-Wayne Hospital, Clifton Springs Hospital, and United Memorial Medical Center in Batavia.
In the email to staff, Rochester Regional says it has $400,000 of unpaid bills from outpatient surgeries in the last month. “(The) vast majority are full deductible and/or co-insurance with no upfront or later payments ever being made,” the email says.
It also states Rochester Regional is “looking to be financially responsible and capture patient responsibility portions prior to services as we currently request in the practices.”
Rochester Regional provided an example to News10NBC:
“If a patient’s portion of responsibility after we contact their insurance is $2000, they will be responsible for paying $2,000 prior to the surgery or they could pay a minimum of 25% (IN THIS CASE, 500 DOLLARS) and enter into a no-interest payment plan to pay the remainder. Under both scenarios, the end cost is the same for patients.”
While this pay upfront policy is legal in New York, the state health department told News10NBC,
“Hospitals cannot deny patients admission, treatment or services that are reasonably believed to be medically necessary because of an unpaid bill.”
The Rochester Regional email states any surgery deemed medically necessary “will move forward… as currently practiced.” If not, it will be “rescheduled” to figure out a way to pay.
Rochester Regional says under its policy, it does not sue patients for unpaid bills. UR Medicine does not collect money prior to surgeries from patients with insurance. If there’s no insurance, UR Medicine asks for 50% of a patient’s fee. Both systems say they offer generous financial help.
However, State Senator Liz Kruger, Chair of the Finance Committee and author of a bill that caps the cost of outpatient hospital charges, sees two issues. One is defining what falls under “emergency” or “medically necessary.”
Liz Kruger, Chair of Finance Committee, NYS Senate: “And then the other variation is people think – ‘oh, what is a co-pay? It’s $20.’ No.”
Sen. Kruger says 700,000 New Yorkers have high deductible insurance plans.
Liz Kruger: “Who’s got $18,000 to pay for some kind of surgery that might not be emergency like opening up your heart and saving your life but could be surgery on your back, surgery on a hernia.”
Berkeley Brean, News10NBC: “You think this is going to come up at your hearings in January and February?”
Liz Kruger: “Only if people come and bring it to us. It turns out there was an attempt to now allow this in a state law that did not get done in previous years. And I’m certainly going to be talking to the chair of the health committee in both houses.”
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