Hospitals cannot charge self-pay patients more than they charge insurance companies

Hospitals who bill insurance companies for care rendered to a patient often accept from the insurance company an amount that is significantly less than the billed amount.  A person without insurance then may have to pay more for the same care as that rendered to someone with insurance.

New Hampshire law remedies this inequitable situation.  RSA 151:12-b provides, “When billing self-pay patients for a service rendered, a hospital . . . shall accept as payment in full an amount no greater than the amount generally billed and received by the hospital for that service for patients covered by health insurance.”  A hospital must also provide notice of this requirement both at the time of the service as well as when it bills the self-pay patient.  This statute only applies to hospitals, which is defined in RSA 151-C:2 to include “an institution which is engaged in providing to patients, under supervision of physicians, diagnostic and therapeutic services for medical diagnosis, treatment and care of injured, disabled, or sick persons, or rehabilitation services for the rehabilitation of such persons.” The term hospital also includes psychiatric and substance abuse treatment hospitals.

But what amount must be accepted by the hospital for a self-pay patient?  The statute states that the payment amount is measured by the standards articulated in the Patient Protection and Affordable Care Act of 2009.  The relevant portion of Section 9007 of the Patient Protection and Affordable Care Act of 2009 mandates that the amount the hospital can bill a self pay patient is “not more than the lowest amount charged to individuals who have insurance covering such care.”  This amount may include the rate charged by Medicare and Medicaid.  

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