If patients call to request a price estimate at one hospital, they’re probably calling other hospitals, too. Some patients will pick the service at the cheapest price quoted, but this doesn’t tell the whole story.
“There are so many competitors. Families need to have the sense that they are the decision-makers,” says Stacy Hutchison-Neale, CRCR, CHAA, preauthorization department supervisor at Nemours/Alfred I. DuPont Hospital for Children in Wilmington, DE.
Patient access staff at Trinity Health in Livonia, MI, use automated tools to provide estimates to patients online, over the phone, or in person. “The more detail the patient can provide, the more accurate the estimate,” says Linda Schaeffer, vice president of patient financial services. To get a more accurate estimate, Schaeffer says “we compare to our negotiated payer contracts and claims data history.”
There are two issues Hutchison-Neale sees regarding price estimates:
- Patients don’t provide enough information. “Patients, when calling around, do not have the correct CPT codes for the procedure that they are requesting,” Hutchison-Neale says. Staff explain that they need more than just a generic description of the service to give an accurate estimate.
- Things can change. Sometimes, price estimates given preservice change because additional procedures are necessary. For instance, a patient may be under anesthesia longer than anticipated, or a condition is discovered that surgeons must address during the procedure.
Patient access staff explain that an estimate is based on the information that’s known at that point, and can change based on medical needs. “Families have a misunderstanding that an estimate is their final cost,” Hutchison-Neale notes. Education about benefits from the very first contact “is very important,” Hutchison-Neale adds. “Provider and facilities should have educated, confident patient access staff.” Price-shopping patients often encounter patient access staff who don’t seem fully confident in the information they’re providing. Sometimes, staff are unsure who to direct the caller to for assistance. “The families automatically begin to question the estimates and accuracy,” Hutchison-Neale reports. This is where education comes into play. It gives an impression that the hospital cares not just about the person’s medical well-being but their financial well-being, too, Hutchison-Neale offers. “They are more likely to have services where they get the full package.”