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Uninsured? Plan to pay more

Insurers have the clout to get better deals. Individuals must negotiate for themselves.

One of the ironies of hospital pricing is that people without insurance may be asked to pay significantly more than insurance companies, which use their clout to negotiate lower fees.

Uwe Reinhardt, a Princeton University health economist who chaired the New Jersey Commission on Rationalizing Health Care Resources, used the example of a limo driver who was charged $1,280 for an emergency visit. With Reinhardt's help, the bill was reduced to $80.

Based on recommendations from Reinhardt's commission earlier this year, the New Jersey Legislature passed a bill last month that would limit the amount hospitals could charge the uninsured to what Medicare would pay for the same service, plus 15 percent. The bill, which applies to people with incomes up to five times the federal poverty level, still needs the governor's signature to become law.

Hospitals in New Jersey already are required to provide free care to those who make less than 200 percent of the federal poverty level.

Pennsylvania has no caps on bills. Kenneth Braithwaite, who leads the Delaware Valley Healthcare Council, said it was better for hospitals and market forces to set limits.

Hospitals in the region say they reduce bills for uninsured patients, but their policies vary considerably.

First, they try to enroll as many uninsured individuals as possible in Medicaid, the government insurance program for the poor. Many who do not qualify are offered free care, based on their incomes.

At Temple University Hospital, for example, patients get free care if their income is below the federal poverty level - $10,400 for one person - and there are discounts for those earning up to three times the poverty level. Above that, bills are based on what a private insurer would pay, said Ray Robinson, associate vice president for revenue cycle.

Abington Memorial Hospital patients are eligible for free care if they make up to 400 percent of the poverty level. That's $85,000 for a family of four. Care for patients with higher incomes is discounted, and no one is asked to pay more than 10 percent of annual income.

Hospitals that are part of the Main Line Health System give free care to people who make up to two times the poverty level and offer discounts off charges - list price - ranging from 65 to 75 percent to those who make up to five times the poverty level. Uninsured people with higher incomes - the system had 13,000 of them last year - are given a 60 percent discount for emergency care and a 40 percent discount for elective treatment.

Michael Buongiorno, the system's chief financial officer, said Main Line Health collected less than 10 percent of what it billed uninsured patients last year.