Clearing Up Price Transparency – By: Mary Ellen Pratt, FACHE, CEO
As “Black Friday” approaches, consumers are starting to search for online ads and making plans to find a copy of the Thanksgiving week sale papers. Some of us will search for weeks to save a few hundred dollars on a TV or designer purse.
Now imagine walking into a store without prices, grabbing a TV blindly and then getting the bill for it mailed to you. This is how many people feel when it comes to healthcare costs. This feeling of being uninformed and the steadily increasing amount of out-of-pocket healthcare expenses, have led to the call for pricing transparency in hospitals. Thus, resulting in new legislation from the Centers for Medicaid and Medicare (CMS) requiring hospitals to make their standard charges available via the internet in 2019.
We agree with the purpose.
According to livestrong.com, healthcare is one of the top 10 largest expenses of the American Family (and also one of the most important!). As consumers ourselves, we understand the importance of helping patients “shop” for certain healthcare services by giving them access to quality, safety, satisfaction and pricing information. Healthcare is a large investment and patients should have the right to choose a hospital based on many different factors.
But, there is a difference between charges and out-of-pocket costs.
Understanding the difference between posted charges and out-of-pocket expenses is a great way to be a better informed consumer. In accordance with the law, we will be posting hospital charges on our website www.sjph.org. These charges are the federally-required maximum list price for certain services. When comparing it to typical consumer goods, imagine it as the “retail” price of an item that has not yet been discounted by a coupon, sale, special or contracted rate. Virtually no one will pay these “retail” prices or charges.
What possible variables make out-of-pocket costs less than charges?
Getting a price for a health service is not as clear as a retail item such as a TV, because healthcare prices are based on many different factors and formulas unique to every patient and every hospital. The price a patient pays is based on factors such as contractually negotiated rates from private insurance companies and internal financial assistance programs. In addition, CMS reimburses hospitals based on complex formulas that often pay less than the amount on the charge list.
How do you get a clearest estimate of out-of-pocket expenses?
1. Call the number on your insurance card. Since insurance companies often offer contracted rates for certain services, insured individuals are encouraged to contact Medicare or their commercial insurer to discuss factors that can affect price such as:
- plan design
- provider networks (in-network usually costs the patient less compared to out-of-network)
- individual out-of-pocket responsibilities (deductibles, coinsurance, out-of-pocket maximums)
2. Sign-up on your provider website. Most insurance companies also have secure websites that offer you a real-time snap shot of your plan offerings, out-of-pocket expenses and deductible amounts met. In addition, the website may allow you to create an individualized estimate of patient expenses based on a provider, service and/or hospital.
3. Uninsured patients are encouraged to contact their hospital’s Financial Services Departments to discuss options and request customized estimates.
What you can expect from us.
In January 2019, we will be posting our hospital’s list of charges. which once again, are not what most people can expect to pay out-of-pocket. We encourage you to first contact your insurance provider to ask the specific details about your plan (mentioned above). With this information, you can contact our Financial Services Team by calling 225.869.5512, option 6 to request a customized estimate of expenses based on the details you provide. In addition, if you are uninsured, our team can help determine if you would qualify for our Care Aid Program.
To sum it up, transparency can be foggy when it comes to pricing for healthcare services, but we are always here to help. We want you to know that our vision is to provide you the most value when it comes to cost, quality, safety and satisfaction.
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