Understanding UCLA Health's Cash Payment Policy
Navigating the complexities of healthcare costs can be daunting. UCLA Health is committed to providing patients with the information they need to make informed decisions about their care. This article breaks down UCLA Health's cash payment policies, financial assistance programs, and other resources available to help manage healthcare expenses.
Financial Assistance Programs
LA Health Services is dedicated to ensuring patients have access to coverage through Medi-Cal or financial assistance via their Financial Assistance Programs. For Los Angeles County residents, the "Ability to Pay Program" (ATP) offers no-cost services for patients with incomes at or below 200% of the Federal Poverty Level (FPL). A reduced-cost, sliding scale is available for those exceeding 200% FPL, determined by family size and income.
Accessing Financial Assistance
Patient Financial Services staff are available to assist with applications, answer questions, and facilitate bill payments.
Price Transparency and Consumer Information
UCLA Health aims to provide transparent information to help consumers make informed healthcare decisions. This aligns with the federal Centers for Medicare & Medicaid Services (CMS) recommendations for hospitals to communicate charges in a consumer-friendly manner, aiding patients in understanding their financial responsibilities.
Understanding the Charge Master
The charge master, or charge list, encompasses the billed amounts for all medical and surgical services, essentially representing the retail price. A patient's bill for a specific hospitalization or outpatient visit is a compilation of these individual charges.
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Services Included in the Charge Master
Retail prices within the charge master include room and board (for inpatients), supplies, nursing care, equipment use, nutritional services, and services performed by non-physician hospital staff.
Services Excluded from the Charge Master
It is crucial to note that physician services related to a hospital stay or visit are billed separately and are not included in the charge master. This is because doctors may not be directly employed by the hospital, even if they work within it. Consequently, patients may receive separate bills from doctors who provided treatment during their stay, including radiologists, anesthesiologists, and pathologists.
Impact on Health Insurance
Insurance companies reimburse healthcare providers based on their individual contracts. A patient's financial responsibility varies depending on their insurance coverage.
Obtaining Pricing Guidance
When seeking a price quote, it's helpful to have the following information ready:
- Physician referral, including a description of needed services
- Name of UCLA physician
- Insurance card (if insured)
While UCLA Health strives to provide a pricing range based on historical data, estimated prices are not guaranteed. The actual treatment received may differ from the services used to compile the estimate.
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Cash Pricing for Selected Services
UCLA Health provides cash pricing for specific services, which must be paid in advance. In these cases, insurance will not be billed, and claim forms will not be provided. The cash pricing covers hospital and physician charges, including anesthesiology, radiology, and select peri-operative tests. These cash pricing estimates are valid for 30 days from the agreement date and are subject to change. A signed agreement is required, stipulating that these services are not billable to health insurance. Payments can be made via cash, checks, or major credit cards. Note that not all procedures at UCLA are available for cash quotes.
UC Employee Health Plans
The University of California (UC) system offers various health plans to its employees, retirees, and their dependents. These plans are designed to provide access to UC medical centers and manage healthcare costs. Here's an overview of some key aspects:
Western Health Advantage
UC Davis Health discontinued primary care services through Western Health Advantage for UC employees, retirees, and their dependents. Members were given the opportunity to choose a new medical plan during open enrollment. The UC Blue & Gold network closely mirrors the provider network available through Western Health Advantage.
Prescription Drug Costs
To maintain affordable prescription drug costs and premiums, CORE, UC Care, and UC Health Savings Plan transitioned from the Anthem National Drug list to the Anthem Essential Drug list. While most members will not experience significant changes, some may see adjustments in their copays depending on the medication tier.
Supplemental Health Plans
UC's supplemental health plans provide additional protection against unexpected health events, complementing existing medical or disability coverage. These plans offer pre-determined cash payments for injuries, illnesses, or hospitalizations, regardless of actual medical costs or lost income.
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- Critical Illness: Provides a lump-sum payment upon diagnosis of specific illnesses, such as cancer, heart attack, and stroke, based on the chosen coverage level ($10,000 or $30,000).
- Hospital Indemnity: Pays a pre-determined amount upon hospital admission due to accident, illness, or maternity care.
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