At Maury Regional Medical Center in Columbia, TN, many price-shopping patients are calling.

“Most requests are individuals without any insurance wanting to know expected out-of-pocket costs,” says Preservice Manager Jennifer Smith. These are examples of questions posed to patient access staff:

  • What laboratory testing service provider does the hospital use? What will lab work cost? Self-pay patients want to know if lab work is included in the price they are quoted. If not, patients want to know they are receiving the best possible price for the lab work. As for insured patients, they are worried about whether the laboratory is a covered facility, and whether the lab work is a covered test. “The patients do not want surprise costs. They really seem to understand what they are looking for,” Smith observes.
  • What will the scheduled surgery cost?
  • What will screenings ordered by my doctor (colonoscopy, CT lung screening, AAA screening, mammography, or presurgical screening) cost?
  • What will anesthesia cost for my upcoming scheduled surgery?

For all of these questions, staff follow a process:

Tell the caller what information is needed to run the estimate. This includes insurance ID number, group number, the name and date of birth of the primary policyholder, the name of the study ordered and a copy of the order (if possible), what facility the caller is hoping to use, and the best contact number to reach the caller. Most people can recite this basic information easily. The trickier question is about CPT codes. “The CPT code is the most difficult information to identify,” Smith notes.

Many people have never heard of CPT codes. In that case, staff have to conduct some research. First, staff contact the provider’s office to ask for the anticipated CPT codes they will be using. If the provider cannot provide the CPT codes, staff calculate a “good faith” estimate (based on CPT codes that are associated with the procedure). “We use this time to educate the caller on the reason for accurate CPT codes,” Smith adds.

Tell the caller how long it will take to receive an answer about the cost of care. Assuming the caller knows all the information up front, the call takes only five or 10 minutes, and an additional three to five minutes for scheduling. If the caller does not know the information, staff ask for some additional time to research it and run the estimate. Those callers can stay on the call, receive a call back to discuss it later, or receive an email with the information. “If the caller is happy to stay on the line, we make small talk. We show them we care,” Smith says.

Choose wording that empowers the patient. “People get upset when they feel they have no control or say over what’s happening,” Smith says. To counter this, staff use specific wording: “For us to process your estimate today, we will need the name or procedure code of your exam. Are you ready to start? With your permission, I can call your physician to learn the information so we can proceed. Are you OK with me doing that for you?”

Explain the next steps to schedule the appointment. “We coordinate a warm transfer of the call to get them scheduled,” Smith says.

Some callers are worried about their insurance coverage. The preservice team provides reassurance, that the insurance has been verified already and that prior approvals are obtained before the procedure. “For self-pay patients, there are many questions about financial assistance,” Smith says. “We connect them with financial counselors.”

Thank the caller for considering the hospital as an option. “We always ask them if what we have communicated to them makes sense, or if they need any clarification of the estimate,” Smith says.

It is not just a dollar amount that is at stake. The calls are a chance for patient access to give a good first impression of the hospital. “People skills are a must. We are polite, courteous, and timely with any commitments made,” Smith says.

Set clear expectations of what will happen during the patient's stay stay. The preservice staff see their role as more than just giving people information on insurance coverage and dollar amounts. “We ease their fears of coming to the hospital,” Smith adds.