Recent premium increase for United Healthcare coverages

[jphorenci]

I am absolutely appalled at the just announced price increases for United Healthcare coverage. The increase in RX (over 90%) announced during the last open enrollment was enough force me to make a change and now the supplemental health coverage increase (22%) is astounding. As their primary selling agent, you should anticipate my changing to another, more affordable carrier at my first opportunity and hopefully a boatload of others doing the same. Shameful, unjustified, heartless, and ridiculous. Shame on both you and United Healthcare.  

[GailL1]

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@TRL1111 wrote:

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@pf75974628 wrote:

One of our major facilities no longer takes some Advantage plans because of their sky high denial rates.  That means that the hospital is footing the bills for people who have insurance but can't pay out of pocket.  

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Can you explain what you mean by that?  

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LOL - if what @pf75974628 said was true the facility would be breaking federal law- No facility that accepts Medicare can refuse care based on the ability to pay - The way pf75974628 put it, it would also apply to those who have OG Medicare but pay their part out of pocket - they too might be unable to pay - but in those cases, CMS has a rule as to how any provider or facility can pursue “Bad Debt”. 

@pf75974628 is incorrect - if providers or facilities stop doing business with any particular MA plan it is only because they do inot like what they have negotiated with the MA plan and thus what they are paid by the plan. 

But it may go further than that in many cases - the hospital facility may be contemplating setting up a MA plan of their very own especially if they have successfully bought out many of the surrounding providers.

Personally, when speaking about care denial when it comes to prior approvals - not much of it is actually denied especially if the  provider supplies the necessary info to support the care.  This is currently being enforced with a procedure by CMS - and not just for MA plans - OG Medicare too. 

I believe that we will get to the point where certain treatments are gonna be prior approved by a plan be that plan MA or OG Medicare and we are testing this already in 5-states with some treatments.

[CBtoo]

Gail you said, "No facility that accepts Medicare can refuse care based on the ability to pay - " That is incorrect. They can't refuse EMERGENCY care based on inability or pay or if they don't have insurance or only have out of network insurance, etc. They can refuse other care.

Accepting any form of medicare means that the system is required to have a financial aid program for the uninsured or under insured. HOWEVER that does not mean someone will qualify for it. It depends on the rules of their financial aid program (which can vary - locally for all systems here you can only get financial aid if you have no insurance and are at or below the poverty line for your family size).

Facilities can refuse to be in network with advantage plans. That means if you have one of those "not accepted" medicare advantage plans and choose to be treated there you may well be responsible for the entire amount (depends on whether your particular plan does pay some out of network charges or not, some do and some don't). Further if you don't pay they can sue you for the money and fire you as a patient. When you are fired as a patient you can only go to their ER and not be turned away. You can be refused treatment otherwise.

What you are talking about is original medicare. If a facility accepts original medicare then they can't refuse to treat you. HOWEVER if you don't pay they can do the same thing as already discussed above,

What IS required is that they have a financial aid plan for those who can't pay. Those plans can have income per family size conditions, etc. This doesn't mean that if you can't pay you will qualify for the financial aid plan as that depends on the financial aid plan rules. The only condition is that they have one, not what the details are.

Further if you have no insurance, are out of network, etc. they are allowed to require that you pay X dollars up front before they will treat you and, unless it is an emergency, they can turn you away if you don't do that. 

Often due to the high maximum out of pocket that many advantage plans have, if people need a lot of health care some end up being unable to pay. Those who are, for example, poor enough may have medicare and medicaid (called being dual eligible) and that saves them from huge medical debt. Everyone else who can't afford to pay their share as determined by the plan end up with issues and eventually can be sued and fired as a patient. 

EVEN if someone qualifies for the financial aid plan that does NOT mean care is free or almost free. It just means they will charge you less. If you don't pay you will suffer the same consequences.

There are a few health care systems that will send you to collection and nag you until the statue of limitations runs out (but, for example, MD Anderson Cancer Center, by state law, has no statue of limitations - there may be other systems  that don't too) but not fire you as a patient or sue you. If you know you can't afford your bills you will have using your medicare and don't qualify for their financial aid program OR can't afford what you still have to pay even if they accept your medicare plan, it would be prudent to only use systems that won't sue you or fire you as a patient for not paying.

[GailL1]

@CBtoo 

Not if the ER facility accepts Medicare - If so, they are under the EMATLA and must give ER care to anybody to the extent that they are stabilized.

HHS.OIG.gov - The Emergency Medical Treatment and Labor Act (EMTALA) 

[CBtoo]

See my first paragraph with EMERGENCY care in CAPS - That is precisely and exactly what I said - that they have to give emergency care to anyone regardless of insurance (including medicare) or lack there of, citizenship or not, etc. They can deny care under certain other circumstances - see my post you are replying to. 

[GailL1]

Whoops - Sorry - got an awful headache.  To be clearer, we are talking about Medicare - so a provider or a hospital - inpatient or outpatient - can refuse to see a beneficiary if the beneficiary’s Medicare plan is out of their network.  But if they are a OG Medicare provider that accepts assignment, they cannot refuse to see a beneficiary purely because they think they cannot pay for their part of the cost.  Now a provider can refuse to see them as a patient if they are limiting the number of Medicare patients they are seeing.  But not for their ability to pay - because Medicare does reimburse a certain amount of their bad debt as long as they follow the rules of what they have to do to try to collect.

[CBtoo]

You said, "Now a provider can refuse to see them as a patient if they are limiting the number of Medicare patients they are seeing.  But not for their ability to pay - because Medicare does reimburse a certain amount of their bad debt as long as they follow the rules of what they have to do to try to collect."

That is NOT true for many (but not all) systems once someone has gone to collection for what they still owe after medicare has paid and paid towards the unpaid bills out of that program.

Three of our four local systems - all of whom accept medicare and most, but not all, advantage plans - will sue you and cut off care if you are in collection for more than 3 months.

Your local hospital systems may not do that, but locally they do. They do have to see you even if you have bad debt and been in collection for 3 months after care has been cut off for one month after care is cut off (due to patient abandonment laws) but after that they can deny you care except in the ER. And locally they do do that to people. Lots of people. Even employees (the local systems' rules apply to everyone, not just medicare patients).

It all depends on the system's rules for what they do about patients (including medicare of any flavor) with bad debt that has been unpaid for however long is in their rules.

[pf75974628]

My premium went up by 25% this year.  So I pay part B plus the deductible for a Plan G, I pay for a prescription plan and also pay for a separate dental plan in addition to the Medigap policy.  Managing my health expenses is the most expensive thing in my budget including housing and a car.  I'll soon be priced out of health care except for Part A which I suspect is nearing the chopping block too.  I have friends with conditions they can't get treatment for because their Medicare Advantage plans have denied them.  I don't want an Advantage plan because the advantage goes to the companies denying treatment.  I believe that UHC is determined to move people from Medigap plans to Advantage plans because they want to increase their profits.  At the expense of the nation's retirees.  

[GailL1]

@pf75974628 

If you had to pay for Part A rather than your premiums being paid during your working years, It would be $ 518 a month for 0 - 19 Medicare credits or $ 209 a month for 20 - 39 Medicare Credits.  

Why don’t you switch plans to one that is cheaper in premiums?  Depending on your state and your health, you may of may not have to go thru underwriting.  You can switch anytime so you could at least do some research with either your state’s SHIP office or with an independent Medicare Insurance Broker that represents a lot of different insurers for a MEDIGAP plan.

The High Deductible Plan G has a (2025) deductible of $ 2870 - that will be made up of everything you pay for Medicare except your Part B premiums - but once that has been reached, the rest of the year it works just like your Plan G.

The High Deductible would be the sum of the Part B Deductible, any of the 20% the Medicare does not pay for Part B claims, IF applicable the Part A deductible or charges - ANYTHING that you pay for your Medicare claims up to the deductible amount of (2025) $ 2870 - then after that, for the rest of the year, it works just like your Plan G now.  

So you would always be limited to the High Deductible Plan G amount every year - many of the people I know that have it have NEVER reached this HD amount. They just pay whatever they use but just never reach the HD amount plus as a trade-off their premiums for the High Deductible Plan G are very cheap per month - like less than $ 60 - $ 70 a month or lower - I cannot be specific cause this is insurer and state specific so you would have to check in your state and do the math based on your health and claims.

There are many other Medigap plans to choose from - every insurer may not carry some of them - in fact, I know in some states AARP-UHC does not offer the HD_G plan.  

Medicare.gov - Compare Medigap Plan Benefits 

Rule of thumb - the more risk you are willing to take for your health, the lower your premiums.  If you want 1st dollar coverage  for everything except the Part B deductible like you have now - then that is what you are now paying for - 

Yes, they will all increase in premiums through the years but some not as much as others.  Up to you where and when you want to spend those medical bucks.  

[TRL1111]

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@pf75974628 wrote:

I believe that UHC is determined to move people from Medigap plans to Advantage plans because they want to increase their profits.  At the expense of the nation's retirees.  

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If you object to how they operate, then why do business with them?  UHC isn't the only supplement provider out there.  There's no reason for you to continue to line their pockets.

[NorCalMom]

I'm in the same boat. Medigap G went from $118 - $165 - 191$ and I've only been on it since 4/24. My medical is way more expensive now than when I worked. I think retirement is going to go into the history books as a failed American dream. 

[GailL1]

@NorCalMom 

I will ditto what @TRL1111 said - most likely during your working years your employer was covering the lion share of your health insurance premiums.  

I was always self-employed when I worked and premiums were way, way on up there - thousands of dollars a month for me and my husband (both self employed).  

You also have Plan G - the most lucrative Medigap plan sold to current beneficiaries.  Pays everything except the Part B deductible - $ 257 in 2025.  If you want 1st dollar coverage for everything - inpatient and outpatient - then you are paying for that coverage.  Other Medigap plans would be cheaper in premiums but you would have some other expenses.  The more risk you are willing to take for your health, the cheaper your premiums - plus some other companies might also be cheaper for the SAME benefits.

Medicare.gov - Compare Medigap Plan Benefits 

[TRL1111]

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@NorCalMom wrote:

I'm in the same boat. Medigap G went from $118 - $165 - 191$ and I've only been on it since 4/24. My medical is way more expensive now than when I worked. 

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Are you taking into account the amount your employer paid toward your health insurance?  Actually, do you even know what that was?  Most people don't, and it's a shame that people don't realize how much their employer-sponsored plan actually costs.  

Your Medicare is costing you about $375 a month, with a deductible of $257, and no network limitations.  I'd be shocked if you added how much you and your employer paid toward your premium and it totaled less than $400, never mind not having a network, preapproval requirments for procedures, and a deductible that low.

[Tonster521]

@TRL1111 Many folks do not know how much their employers pay for health insurance. Moreover, they do not realize that the cost of health insurance is part of their overall compensation. As you may not know, employer report the average cost of health insurance on an employee's W2. Because I do taxes for a small group of people, I see amounts that can exceed $14,000 per year for Family Coverage. Most of those larger costs are related to Government Plans (i.e., teachers, law enforcement, Federal, State, County, etc.). Moreover, many of the Government employers require little or no contribution. So, the costs, for the most part, are paid by the taxpayers. When very little is deducted from one's paycheck, it leads many folks to believe that health insurance is not a big cost.

With regard to Medicare, I believe your estimate of approximate $375 per month is low. You may be only considering the monthly contributions for Part B, Part D, and Part A, if any. As GaiL1 pointed out, Part A may cost as much as $518 per month for folks with under 20 Medicare credits. This is in addition to the Medicare Part A deductible of $1,676 and co-pays of $419/day for days 61 thru 90. If you need to use Lifetime Reserve Days 91 thru 150, the co-pays are $838/day. Rather than calculate various "what if" scenarios, just use $518 per month for Part A. This is much easier than calculating 1.45% Medicare Tax imposed on your Earnings throughout your career. For example, you earned $2,000,000 over a 40 year career and paid $29,000 in Medicare Part A taxes. Keep in mind, employers would have also paid $29,000 in Medicare Part A taxes for a total of $58,000 over that 40 year career. We only pay on average 25% of Part B Medicare costs or for 2025 in most case $185 per month. The current estimate of Part B for 2025 is $740 per month. The Federal Government covers the other $555 per month (on average). This is a Welfare Benefit provided by the Federal Government. There are additional costs to consider for Part D. However, there are way to many schemes with various costs. So, for this post, I am simply omitting Part D costs since Parts A and B ($518 and $740, respectively) add up to $1,258 which is significant. I have not tried to guess or add deductibles, co-pays, and coinsurance to the above amounts. The bottom line is Medicare costs are pricey. Folks with Medigap Plans need to add the monthly costs for their Plan to the above totals. Folks without Medigap Plan coverage are self insuring and are taking a huge risk that may be expensive than buying a Medigap Plan. Hope this helps.

[TRL1111]

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@Tonster521 wrote:

With regard to Medicare, I believe your estimate of approximate $375 per month is low. You may be only considering the monthly contributions for Part B, Part D, and Part A, if any. 

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I simply added $185 (Part B premium) + $191 (her Plan G supplement premium).

The poster didn't complain about Part D costs, so I didn't address them.

Since she compared her costs under Medicare to what her employer-sponsored plan cost her, I assume she has enough work credits that she's not paying a Part A premium. And I didn't go into Part A copays because she has a supplement that covers that.

The only thing she mentioned was the increasing premium for the supplement, and Medicare plus her supplement is $375/month.

But I'll point out that she previously posted that she has a condition that requires yearly tests, and those cost over $100,000 a year. I think paying $4,500 a year (Part B premium + Plan G supplement plus $257 Part B deductible) is a smoking good deal for $100,000 of expenses, and that's only those tests--if someone is getting tests that cost $100,000 a year, then they probably have other medical expenses, as well.

[Tonster521]

@TRL1111 You missed the cost for Part A which is paid from your earnings while working. Maybe you think it is free, but it is not. In fact, it is expensive for most folks. Part A requires payments of 1.45% from both you and your employer. I used $2 million for a career earnings which is essentially $50 K per year for 40 years. Folks with a mathematical aptitude may be able to adjust the numbers I used to their own unique situation. So, rather than accumulate the Medicare Part A taxes that one pays over a working career and elect to use a time value factor (i.e. 2.5%, 3.0%, or even 0.0%) for each period of time, I suggested to use the current cost for Medicare Part A which is $518 per month for folks with less than 20 medicare credits. It should be abundantly clear that folks who work long periods of time (35 years and more) and pay medicare Part A taxes have a greater cost for Medicare Part A. Many folks have 40 years or more of Medicare Part A tax payments. You need to account for those Medicare tax payments as well as the payments for Part B and a Medigap Plan, if elected. Also, there are folks that pay Income Related Monthly Adjustment Amounts (IRMAA) for Medicare Part B (and Part D). Their amounts are greater than the $185/month Part B premium. 

[CBtoo]

Presuming you have enough work credits the premiums for A is now "free" to you when retired (not enough work credits and it costs money). That money is "sunk costs". It is money under the bridge so counting it as a current cost (unless you are actually paying a premium for it) is not really relevant to current costs. Of course if you don't have a supplement or an advantage plan then the out of pocket for that is steep if you are hospitalized.  

[Tonster521]

@CBtoo I suggest you review the history concerning Medicare as well as the discussions regarding a National Insurance Plan proposed by President Truman in the 1940's. Hospitalization is the most expensive medical costs that one may incur. Prior to Medicare (1965), only certain folks could afford buying hospitalization after leaving the working world. For the less fortunate folks which were many, families would pass the hat around to raise money for hospitalization. In many cases, the hat did not fill up with enough money. Medicare Part A was the solution wherein a worker would pay along with their employers Medicare taxes for hospitalization coverage to become available after attainment of age 65 or disability (most cases after 2 years). This pay in advance or prepay approach was and is the solution to eliminate an expensive monthly premium that was the case before Medicare. This is a cost whether you choose to recognized it or not. Some folks that are savvy will also develop their cost for Medicare Part A using a future value calculation. In other words, calculate each year's Medicare Part A tax and elect a reasonable interest rate (i.e., 2.0%, 2.5%, 3.0%, etc.) that will compound over a working career. Many working careers are 35 years or more. Instead of developing a future value that will vary from person to person depending on their amount of Medicare Part A taxes paid and length of time worked, I simply used $518 per month which is an amount that the SSA/Medicare developed to reflect the cost of Medicare Part A. So, you may believe Medicare Part A is free because there is not any contribution/premium deducted from your SS Benefit payment. However, you have prepaid for Medicare Part A while working. I will concur that for some folks who live a longer life, their cost for Medicare Part A will be amortized over time to zero. Hope this helps. 

[CBtoo]

I never said it was free. I said factoring in what you paid prior to retiring is taking into account sunk costs, money that you can’t get back regardless. Some people will never see that back in using Medicare. A others will use it a lot. Some paid more into the system than others. In retirement some people actually have to pay premiums for that. That’s different than being free. Paying in advance helps with many people‘s retirement budget (especially since most people are bringing in less in retirement). Some people get back way more than they paid in and others will never break even. Just like with Social Security. Those both work the same way in that respect pay in advance. What you get back before you die is not fixed in stone. Current premiums, however don’t work that way, as we all know.

[Tonster521]

 @CBtoo With regard to the cost for Medicare Part A, please review your first sentence of your June 12, 2025 post. You have clearly stated that if you have enough work credits (Medicare taxes paid), the premiums for Part A are now free to you when retired. I concur that there will be no additional deduction from your SS Benefit payment, but Medicare Part A is not free. All of us have prepaid for Part A when working so that there would not be a huge cost for Part A when we stop working. I understand your view that the Medicare Taxes you paid are not refundable. So those taxes are "sunk costs" because you will never get those taxes back directly. However, you may benefit from those taxes in the future by accessing Medicare Part A benefits. Who pays for those Medicare Part a benefits? Is it you, your fellow workers, employers, the federal Government? If you answered all of the above, you are correct. You appear to have a financial background when you use the concept of "sunk costs". So, you should be aware that designating a cost as "sunk" does not mean those costs do not matter or should not be considered. A good example is the pharmaceutical business. Companies spend large amounts of money research & development, on salaries of biochemists, scientists, etc. and compounds that never make it out of the laboratory. Those costs are "sunk costs". If there is a subsequent successful drug, those costs may be recouped over the years. Until that time, those "sunk costs" are recorded as expenses and are considered. 

So, it depends on the specific context and how the term,"sunk costs", are being used. If you are on a "cash basis" using an out of pocket approach, I understand why you do not recognize the cost for Medicare Part A. However, there is a cost for Medicare Part A coverage and the benefits that are provided when or if needed. You may calculate your own individual costs over your working years which may be cumbersome for most folks. Or, simply use the current amount of $518 per month which the SS actuary has determined to be an appropriate amount for such coverage. At any rate, there is a cost for Medicare Part A. You can use either approach. However, to not recognize a cost for Medicare Part A coverage is understating the costs for your Medicare coverage whether you prepaid or "pay as you go".

[CBtoo]

It is now free to you once you take it IF you have the work credits (otherwise you still pay). That you paid into the system prior to taking it is irrelevant for the to free to you now with respect to not paying premiums for it once you retired. That is all I was talking about.

Sure, some people will have paid into the "system" prior to retirement more than they get back. Personally I'd rather be a "profit center" so to speak to the government for this (and any other insurance company, medicare B, D, and etc.) rather than be sick enough to have to actually use my health insurance (or car insurance or home owners insurance or renters insurance...).

[TRL1111]

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@CBtoo wrote:

I never said it was free. I said factoring in what you paid prior to retiring is taking into account sunk costs, money that you can’t get back regardless. 

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Plus it's just silly.  Under this thinking, people who get $2,000 a month in social security don't really get $2,000 because that number needs to be reduced by what they paid in taxes in order to get that $2,000.  

[Tonster521]

 @TRL111, The math you referenced is why many young folks do not agree with the SS Program. Many believe they will obtain better outcomes from simply investing their FICA payroll taxes over their working career. And for savvy folks who may compound their investments over time, this is true. At any rate, I suggest that you review the Greenspan Commission's findings from 1981 through 1982. You can find their Report at the SSA website. It is the basis of the 1983 Amendments to FICA aka Social Security. FYI, the SS Trust was projected to reach zero ($0.00) by August 1983. President Reagan formed a bi-partisan Commission headed by Allan Greenspan to develop solutions and save the SS Program. Prior to 1984, SS Benefits were not taxable. The reasons vary. However, one reason was that workers already paid federal income taxes on their earnings and then were subject to FICA payroll taxes on such earnings. That view changed in 1984 after the Greenspan Commission noted that SS benefits were funded 50%/50% by employee/employer. Because the employer did not pay federal taxes on their 50%, that shortfall was shifted to the SS Beneficiaries receiving SS payments if their income exceeded certain thresholds. This provision (50% taxable) was agreed upon rather than an "exclusion ratio" which is the approach you reference. In other words, your SS Benefits are not income until such SS Benefits exceed your FICA payroll taxes. It should be noted that any federal income taxes obtained via the 50% tax approach is returned to the SS trust and not directly kept by the U.S. Treasury. So, folks with other income that exceed the thresholds established in 1983 are, in effect, repaying their SS Benefits back to the SS Trust via the federal income tax provisions. So, there are a number of approaches to consider. First, will you and/or your survivor live long enough to exceed the amount of FICA payroll taxes that you and your employer(s) have paid during your working career. Second, you need to adjust the amount of SS Benefits paid to you by the amount you may be required to repay the SS Trust via the federal income tax provision. The time periods will vary from person to person, but generally, most receive their FICA payroll taxes back within 5 to 10 years. Based on income, approximately 50% of the folks are repaying the SS Trust every year via the federal income tax provision. In 1993, the federal income tax was increased from 50% to 85% of SS Benefits taxable. If you elect to do a thorough analysis of your situation, it will require a mathematical approach. If you use a future value approach using the time value of money and a reasonable discount rate of 5%, many never receive their FICA payroll taxes including employer(s) FICA taxes back over their lifetime. This does not include the federal income provisions which may make it even more difficult to recoup.

[TRL1111]

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@Tonster521 wrote:

At any rate, I suggest that you review the Greenspan Commission's findings from 1981 through 1982. 

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I'll pass, because it has nothing to do with how the increases in Medicare supplements are affecting people's budgets during retirement.

[CBtoo]

Lots of people take into account sunk costs for many things which makes no sense. Regardless of your sunk costs, if your income level says you get $2000/mo gross when you retire that is the size of the check minus whatever is taken out (for example B, etc.). 

I also (and this is an aside to this thread) the people who decide to take SS at 62 (who don't have to for other reasons) so they are more likely to get everything back they paid into it aren't thinking either. If you don't have other sources of income it would make more sense to wait to get the higher amount at 70 (if you can afford to wait) as you may well need that higher amount later when you can't earn extra income. You may never get back everything you paid in, but having a higher monthly income would certainly be helpful to many.

[kasyy]

however - as in my case - many people (myself included) do not want to wait to full retirement age.  We're tired of working after working 40+ years - taking SS at 62 made lots of sense for me while I worked a small job and kept contributing to the tax "fund".  I am now 78 and it worked for me!  Not trying to say it's best for all - but certainly works out in many cases.  But we saved while working so we had our "IRA nest egg" to help.  I know it can't work for all but it sure worked for us!  JMHO

[CBtoo]

I agree with you. The argument used here for advantage plans is exactly what so many agents will say. They are healthy now. They can't afford the premiums. And then how the heck will they afford the out of pocket? Sure they can use a system (if there is one locally and if it is decent) who won't send you to collection, then sue you and cut off care if you don't pay, but most systems will do that. Also more systems are requiring you to pay your co-pay before they will see you. The Cleveland Clinic system (top hospital system in the country) is doing exactly that (they have sent several emails telling us if we don't pay they will reschedule our appointment).

And when they are not healthy and actually sue their care then they may not be able to switch to a supplement and so will be screwed with huge out of pocket. Of course agents get paid a huge amount more selling advantage plans then supplements + D.  Of course medical underwriting exists precisely so the supplements don't just have only sick people on them (which drives the costs up thus the premiums up). The problems exist for people who make too much to have medicaid with their medicare but not enough to pay high medical bills (typically people 135-400% of the poverty line have the most trouble paying medical bills).

With the added issues of limited networks, often no out of state care and much higher maximum out of pocket for out of network care (if it is even covered) the so called "advantage" plans are really more like disadvantage plans.

[GailL1]

@CBtoo 

The Cleveland Clinic reversed their decision within days after making it - 

Cleveland.com- 05/28/2025 - Cleveland Clinic reverses ‘pay now’ co-pay policy  

[Tonster521]

 @gail1 I wonder if the Hippocratic Oath had anything to do with the reversal. Can you imagine asking your employer to pay you before you perform any work?

[CBtoo]

As I use the Cleveland Clinic I'd I'd imagine it was patient blow back and too many cancelled apts as patients didn't come prepared to do that. That causes income loss. I'd guess they were motivated by income loss.

There, local to me (CC is not local to me), a medical system that requires (or at least tries to require) prepayment of the copay before you are seen. They don't turn you away though if you don't pay but they apply a lot of pressure. All four systems want prepayment but they won't turn you away if you don't. However 3 of the 4 systems will refuse to see you if you never made your prepayment and it is in collection and you don't have a payment plan you are sticking with. 

[CBtoo]

Glad the hear that however they didn't send out an email telling us that - just 2 or so emails telling us they were going to do it.