Changes to Medical Center Billing and Collection Practices

September 13 2019
UVA Medical Center

As promised earlier this week, today we are pleased to announce some significant changes to our billing and collection practices in the Medical Center. These changes will reduce medical bills for our low-income patients and those without insurance. They will also reduce our reliance on the legal system for the collection of debts, enabling us to focus our efforts on workable repayment plans.

The changes in billing are as follows:

  • For patients at or below the federal poverty level and who meet the current state asset test, we currently write off 100% of the charges. Patients who fail to meet the asset test currently only receive a 20% discount. (The state-approved asset threshold is $3,200 for a family of four.) Moving forward, we are going beyond state reimbursement rules and providing additional relief. Patients at or below the federal poverty level who have less than $50,000 in assets will have their bills written off entirely. It is worth noting that a home, a car, and up to 3.99 acres of land are not included in the calculation of assets.
  • For patients between 101-200% of the federal poverty line, we currently use a sliding scale for billing, depending on income. (200% of the federal poverty line is roughly $25,000 for an individual and $51,500 for a family of four). Going forward, patients in this income bracket who have less than $50,000 in assets will also have their bills written off entirely.  
  • For patients between 201-300% of the federal poverty line, we currently write off 20% of charges if patients are not insured. (300% of the federal poverty line is roughly $37,000 for an individual and $77,250 for a family of four). Going forward, we will write off 60% of the charges for those within this income bracket who have less than $50,000 in assets and are uninsured.
  • For those between 301-400% of the federal poverty line, we currently write off 20% of charges if patients are not insured. (400% of the federal poverty line is roughly $50,000 for an individual and $103,000 for a family of four). Moving forward, we will write off 50% of the charges for those within this income bracket who have less than $50,000 in assets and are uninsured.
  • For those who are not insured and who are over 400% of the federal poverty line, we currently write off 20% of their charges. Moving forward, we will write off 40% of their charges. We will do the same for those below 400% of the poverty line who have assets over $50,000.

In terms of our collection practices, we recognize that lawsuits, property liens, and garnishing wages can be not only disruptive but devastating. We would much prefer to work out a reasonable repayment plan, and that is where we will devote our attention and energy going forward. For that reason, absent unusual circumstances, we will generally reserve filing suit for those cases involving balances over $1,000 owed by individuals earning over 400% of the federal poverty level (which, again, is $103,000 for a family of four).

These changes will require adjustments to our billing system and will therefore officially go into effect on January 1, 2020. That said, we are committed to working with anyone who currently has an outstanding balance or debt that they are struggling to pay. If you need assistance in this regard, please call 434-980-6110 beginning Monday, September 16.

These changes represent a first step. In the coming months, we will be examining additional ways that we can improve our billing and collection system, including taking a close look at how we treat our own employees and our students, and how we price our services. We will form a working group consisting of internal and external stakeholders to examine best practices at other institutions, identify areas of additional improvement, and propose solutions not simply for the University but also for the Commonwealth and beyond. We will also monitor the changes that we are putting into place and make adjustments as needed. We hope that we can use this experience not simply to improve our own practices and policies but to help lead others to do the same.

As a medical center associated with a public university, our mission is to provide excellent care to anyone who needs it. In practice, this means we treat a comparatively higher number of patients who cannot pay. At the same time, we are legally required, as a state agency, to collect money owed to the state. This can be hard to balance, but we can and will do better than we have in the past. The changes we announce today are a first step toward finding a better balance, so that the humane values and compassion that drive our medical care also guide how we treat our patients once they leave the Medical Center. 


Eric Swensen
Public Information Officer
Phone: 434.924.5770
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