More on Billing and Collections

Zuckerberg San Francisco General Hospital to halt "balance billing" amidst uproar from patients smacked by massive surprise bills

Privately insured patients have gotten hit with bills in the tens of thousands after receiving care at the hospital.

Beth Jones Sanborn, Managing Editor

Courtesy <a href=""> UCSF </a>Courtesy UCSF

Public Health officials in San Francisco have entered a fray kicked up by a much-lamented billing practice of Zuckerberg San Francisco General Hospital that patients argue has saddled them with massive medical bills despite having insurance.

City officials are considering implementing a cap on out-of-pocket payments that patients are responsible for after their insurance pays its part for emergency care at the public hospital, which treats most Medicare, Medi-Cal and uninsured patients. Less than 10 percent of the patient load there is privately insured. The hospital is managed by the San Francisco Department of Public Health.


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Public health officials have suspended the practice, known as "balance billing" as they consider the path forward and other alternatives. The hospital is out of network for all private insurance plans, so when these patients receive care SFGH, as it is sometimes called, their insurance will pay a portion, but patients told the San Francisco Examiner that they have been left with thousands, or tens of thousands, in out-of-pocket costs, plunging them into debt.

One patient said her bill was more than $13,000 dollars and a city leader said he himself fell victim to the practice after being hit by a car ten years ago.


Balance billing is allowed under state law for Preferred Provider Organizations, or PPOs.

As part of a comprehensive plan in the works, public health officials are proposing improved communication between the hospital and its patients throughout the billing cycle as well as an overhaul for current procedures that decide eligibility for financial support programs like sliding scale and charity care prior to the patient being billed. Those programs cover patients who fall within 500 percent of the federal poverty threshold or those that make $60,000 a year.

City leaders say they will also pursue agreements with private insurance companies.

City leaders set a 90-day time limit for the plan to be finished. Other elements of that comprehensive plan include: adjusting charity care and sliding scale policies to expand eligibility; revise the hospital's catastrophic high medical expense program to support more patients who are faced with high, unexpected bills; streamline the process of applying for assistance; and work with state partners to explore additional efforts to improve insurance payments.

They are also exploring in-house opportunities to improve the patient financial experience and are examining regional hospital pricing compared to its own, according to a press release from the office of the mayor.


"The billing practices at Zuckerberg San Francisco General Hospital and Trauma Center for privately insured patients who receive trauma and emergency services are not working for some of our patients, said Greg Wagner, chief financial officer for the Department of Public Health. "Keeping the patients' experience as the focal point, we will explore ways to protect patients from financial hardship, increase participation in financial assistance programs and where possible, recover costs for services from insurers to avoid lost revenues to the city."

"While hospital billing in the United States is very complicated, patients should not be caught in the middle of disputes between hospitals and insurance companies," said Susan Ehrlich, CEO of ZSFG. "At ZSFG, our mission is to provide high quality health care and trauma services with compassion and respect to everyone in San Francisco. We are working to ensure that our billing practices better align with that mission. We are sensitive to people's circumstances and our patients come from all over the economic spectrum. We cannot solve the problems of the entire health care system, but we can do better to serve San Franciscans, who consistently have supported ZSFG and the rest of the City's excellent public health programs and services."

Twitter: @BethJSanborn
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