Nowadays, when you visit the hospital, you'd better make sure you bring your checkbook, cash or a credit card along with your insurance card.

The Westerly Hospital announced this week that it would start asking patients to make their insurance co-payment when they come in for care, rather than wait for a bill. Co-payments -- the portion of medical bills that private health insurance companies expect patients to pay -- vary widely, but $50 or $75 for an Emergency Room visit isn't uncommon.

The Westerly Hospital is simply following the lead of other nonprofit hospitals, said Cristine Vogel, commissioner of the Connecticut Office of Health Care Access, which regulates hospitals. She noted that physicians' and dentists' offices have long collected co-payments from patients when they come in for their appointments, and hospitals should be no different. Hospitals are waiving the practice whenever care is needed immediately, she added, and are not withholding care from anyone who is unable to pay.

"Maybe the question should be, ‘Why haven't hospitals done this sooner?' " she said. "Hospitals need to collect their money, and they have limited resources to do that."

"So far it's worked out well," he said. "Health care institutions in general are entering a new era when they have to deal with far from adequate insurance reimbursements and growing numbers of uninsured patients, so it's imperative that they pay attention to the bottom line."

He added that hospitals need to generate enough revenue to maintain current operations and to enable investments in new technology and programs.

At Lawrence & Memorial Hospital in New London, a limited number of departments have begun asking patients to make co-payments when they come for care, and more departments will begin the practice in the next year, spokesman Kelly Anthony said.

"Many hospitals have been doing this for more than a decade," he said. "It is recognized as ‘best practice' in financial management, and consumers are accustomed to it in other settings."

David Tranchida, spokesman for The Westerly Hospital, said implementing the new payment procedure required training for hospital staff and may take some getting used to for patients, who are used to receiving a bill from the hospital before making any payments. The change is needed to strengthen the hospital financially, he said.

The new procedure will make registration and admission processes more efficient, hospital President Charles Kinney said in a statement. It will reduce paperwork, billing confusion, reduce collection costs and decrease bad debt, the statement said.

"In our efforts to treat as soon as possible those patients who come to the Emergency Department," he said, "we sometimes fail to get adequate insurance information and in many cases we are unable to ask them for the co-payment. That means we need to pursue insurance information and the payment after they leave and that is inefficient for us and the patient.

Nonprofit hospitals such as Westerly, Backus and L&M already provide millions of dollars worth of free and reduced-fee care to patients who lack insurance and cannot afford or refuse to pay. The Westerly Hospital, for example, absorbs $3 million in uncompensated care annually, and Backus provides about $3.3 million worth.

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