Finance questions? You have the answers

Patients want detailed info on costs

Registrars at Hennepin County Medical Center in Minneapolis field five or six calls every day from patients asking detailed questions about what services will cost them, says Laura Florine, manager of patient financial care services. "Patients may postpone care if they are not sure about the cost of the service," she adds.

Some of the calls are from insured patients with significant deductibles shopping around for the lowest prices, she says, and others are from uninsured patients who are inquiring about discounts. "If they have already been enrolled in one of our discount plans, they want to know what that will mean for a particular service they would like to or need to have done," she says.

Patients are not always exactly sure what service to request pricing information on, though, says Florine. "They may not be able to articulate the name of a procedure, for example, but know that it relates to their hip or knee," she says. "When the caller is one of our patients, we can try to contact the referring clinic for additional information."

However, when the caller is not an established patient, adds Florine, registrars don't have any way to get more specifics on what services are needed, such as whether a magnetic resonance imaging test is needed with or without contrast. "If we can gather more information, we will do so. Otherwise, we give them a price estimate range for that service," she says.

Actual charges vary

Estimating changes for services that aren't performed regularly at the hospital is difficult because there might be no other cases to compare it to, says Florine. Giving price estimates for clinic visits also can be tricky.

"Providing the price estimates based on level of service is very straightforward. The complicating part is that we don't necessarily know what other charges may be associated with the visit," Florine explains. Registrars don't know if the provider will be ordering labs, for instance, so patients are informed that if other services are provided, these might not be included in the estimate.

Sometimes a caller informs a registrar of his or her coverage and asks what the out-of-pocket expense will be for a certain service. "We do not have a tool at this time that pulls the price estimate for a service and bounces it off of a patient's individual coverage plan and what is left on the patient's deductible," says Florine.

In this case, registrars provide an estimated cost of the service and refer patients back to their insurance representative for specifics.

A refund is provided if the patient makes a payment up front and the service actually costs less than the amount quoted and paid, says Florine. The patient is billed for the difference if the service costs more. "We stress with each price provided that it is an estimate, and the actual amount may vary based on a variety of factors," says Florine. The patient might have an unforeseeable complication that changes the service from an outpatient procedure to an inpatient stay, for example.

The department is contracting with a vendor for a price estimate tool to simplify the process for generating a price quote based on ICD-9 and CPT codes and calculate the patient's expected out-of-pocket obligation using the contracted allowable amount for the service. "This will be calculated against the patient's benefit information, looking at the deductible, the out-of-pocket maximum, and the co-pay amount, and how much of these have been met," Florine says. (See story on steps to take if services aren't covered, below.)

Source

For more information on responding to patients' financial questions, contact:

• Stacey Bodenstein, General Manager, Admitting & Registration, TriHealth, Cincinnati. Phone: (513) 569-6212. Fax: (513) 569-6619. E-mail: Stacey_Bodenstein@trihealth.com.

• Laura Florine, Manager, Patient Financial Care Services, Hennepin County Medical Center, Minneapolis. Phone: (612) 873-7612. Fax: (612) 904-4219. E-mail: Laura.Florine@hcmed.org.