Patients need to be informed that if their services change for any reason, then their out-of-pocket costs probably will change too.
“The codes are going to change, which may change how insurance processes the procedure,” explains David Kelly, director of revenue cycle at Mary Rutan Hospital in Bellefontaine, OH.
Estimates are much more accurate since the department implemented a price estimator from RelayHealth in Alpharetta, GA. “We have had some solid successes with that tool,” says Kelly. Previously, staff members simply looked at the gross charge listed on the hospital’s chargemaster and gave the patients that number. Still, the patient’s final out-of-pocket cost is sometimes somewhat higher or lower than what was quoted.
“Most patients understand the complexity of healthcare, but not all of them do,” says Kelly. Some patients end up owing more because the estimate was based on a CT scan without contrast, and it turned out that a CT with contrast was needed. Patients might need six weeks of therapy instead of the estimated two weeks, or a planned laparoscopic surgery might have to be converted to open surgery.
“Plain language” is the best way to prepare patients for this possibility, says Kelly.
“There’s going to be a margin of error,” he adds. “We’re still not anywhere close to what people expect from airlines — ‘How much is my ticket going to cost?’”