The Cleveland Clinic is dropping its controversial policy requiring patients to reschedule or cancel nonemergency medical appointments if they cannot make their copayments at the time of their visit.
The policy was intended to apply to any non-emergency visit that didn’t involve a hospital stay — for example, visits with primary care doctors or specialists, physical or occupational therapists, and procedures performed in a doctor’s office.
The Clinic announced the decision May 28 in a statement titled “Update on Collection of Copays,” which began by stating, “Our process update to collecting insurance copays is not intended to disrupt patient care.”
The Clinic explained that individuals with commercial insurance or Medicare Advantage plans who are unable to pay before their visits can instead pay their copay over time using a 0% interest payment plan.
Medicare Advantage plans are private health insurance options funded by the federal government to provide Medicare-covered benefits as an alternative to traditional Medicare, according to the Commonwealth Fund.
The decision to modify the policy followed weeks of criticism from community members and city officials, who argued it unfairly burdened low-income residents and potentially put their health at risk.
One opponent, Cassandra McDonald, a law and policy analyst who is also a cancer patient at the Clinic, filed a claim May 20 in the Cuyahoga County Court of Common Pleas to prevent the policy from being implemented on June 1. She had argued that requiring patients to pay up front could cause them to miss vital appointments and lead to medical emergencies.
Despite the Clinic's decision to drop its controversial policy, McDonald said she is not ready to drop her legal claim. While the change to the proposed policy was a step in the right direction, it is not enough to address her concerns, she said.
"I do appreciate that they did step back," McDonald said. "But we do not have anything that's permanent. What is stopping them from saying, 'You know what, this is not working so we're going to go back to demanding copays in the next 90 days.'"
Instead, the Clinic needs to pledge to hold off on any requirements for up front copayment for a year or more while it explores options to ease the financial burden on patients, McDonald said. The Clinic also should ensure that future policy changes provide the public with at least 30 days notice as required by law, she added.
Other community members like Mike Jones, who lives on Cleveland’s West Side, had opposed the policy, telling Ideastream Public Media it made him feel like the Clinic cared more about money than people.
“I don't think that's right,” Jones said. “I mean, especially when Cleveland Clinic sits in an area where mostly you have impoverished people. So impoverished people sometimes [are] not going to have the money. It shouldn't even be an option.”
Cleveland Councilmember Richard A. Starr, who represents the Central, Kinsman, Midtown and other neighborhoods, told Ideastream he also opposed the policy.
“Cleveland is a city ranked as one of the poorest in the country,” Starr said. “You can't just automatically come after somebody and expect them, on regular checkups, to have the amount of means to pay right then and there. Sometimes they've got to wait on their check to come in at the end of the month, or at the beginning of the month, to be able to pay for certain things.”
Though most people interviewed about the policy opposed it, some, like Cleveland’s Leonard Wright, believed it was fair to require people to pay these fees up front.
“I think it's a good thing,” Wright said. “I mean, if you go into the doctor, you know you've got to pay a copay. I pay taxes, so a lot of that medical [care] that they're getting from taxpayers — you're getting free medical. You can't pay a $20 copay?”
