VideoKaren M. Kroll, CFO Magazine
February 1, 2007
- Price Transparency @ Alegent Health
Alegent Health in Omaha, Nebraska has created a website tool that allows consumers to find out-of-pocket cost information that is specific to their insurance plan design. For example, if a patient with coverage through United Healthcare accesses the site and selects a procedure, the estimated out-of-pocket cost based on the negotiated contract with Alegent Health will be applied. Alegent Health also hopes to add professional fees - such as anesthesiology, radiology and physician fees - in the next six months to a year. Currently the costs reflect facility fees only. The most frequently utilized hospital inpatient and outpatient procedures, hospital diagnostics (CT, Lab, MRI, mammography, radiology, x-ray), therapy services, select physician clinic procedures, pharmacy, cosmetic procedures and Quick Care are listed.
Consumer expectations continue to rise for information on both cost and quality. As leaders in the healthcare industry, Alegent Health feels strongly about moving towards a more meaningful and transparent system for reporting both cost and quality. Alegent Health hopes that by linking quality scores with personally relevant cost data, patients will have the information they need to understand the value of their healthcare and to make more informed healthcare choices - which will ultimately lead to better health outcomes. To date, some health systems have begun to provide consumers ?list price? or average cost information. Alegent Health?s unique approach is even more customized for the consumer. My Cost provides information based on an individual?s health plan or personal financial situation, to help them more precisely determine the specific cost of the procedure or test to them. **Milton Trabal
Financial Analyst
Alegent Health Midlands HospitalPosted by Milton Ivan Trabal Vargas | Feb 26, 2007 5:18 PM ET
- Well, well, well.
After the remarkable introduction and implementation of HMO's, PPO's and Managed Care,we now find our healthcare systems overpriced, overutilized and overwhelmed. The cost of health coverage unaffordable for most and benefits trimmed with every renewal. Step in CDHC, yet another quick fix. Ok, sticking your finger in the hole of a dam will work - but not for long. The burden of responsibility has now shifted to the unsuspecting befuddled consumer. Where HMO, PPO and Managed Care systems took every shred of medical service cost information out of the consumers hands, CDHC is slapping the consumer in the face with it. Now you are responsible for selecting a good quality physcian, hospital, surgeon, etc at the lowest possible cost with little or no medical knowlege.
No different than shopping for a car, they say - oh really? Have you looked for information on providers, their abilities, patient outcomes and protocols? Have you been able to get or understand side by side comparisons of a surgical procedure and its cost from multiple providers? Perhaps we should have known - most children want to be a doctor or nurse when they grow up, and now they may just have to.Posted by louise wickliffe | Feb 21, 2007 5:28 PM ET
- I tried to be a good health care consumer recently.
Here?s my story?
My teenage daughter recently had a biopsy on a suspicious spot on a birthmark on her head. The pathology report indicated Basal Cell Carcinoma and because of the size,the Dermatologist sent us to a Plastic Surgeon for removal. We were told to decide on a preferred date and call back for scheduling. We chose Dec. 22. When I called the surgeon?s office to schedule the surgery, I was presented with the following ?good news??he had an schedule opening on the 22nd which was good because on that day he would be operating at the independent surgery center that he preferred. The only thing was that the center was not in my provider network. The ?good news?, though, was that they would accept our in-network allowable as payment so the cost would be the same as it would be if the surgery was done at an in-network facility.
Now I had to question how the cost could be the same if my coinsurance was 10% in-network and 40% out-of-network. My Plan was only going to pay 60% after a $300 deductible for out of network services. Even if the allowables were the same for both in and out of network, my math shows a 30% difference in what they would accept and what would be due. The scheduler assured me that the cost would end up being the same. I asked for a written estimate of my costs from an in-network provider to compare with the out of network center (trying to be a good consumer). She said that she could tell me what the surgeon?s estimated charges were but that I could not get an estimate from the surgery facilities until I scheduled the surgery because the providers would not know what codes to use until it was scheduled. I asked if she could just send over the codes for comparison purposes and I was told that could not be done. When I asked, ?Why not?? I was told because that is just how the system works. The facilities do not get the codes until the surgery is scheduled. I guess I could have pulled a few more teeth and spent some more time waiting by scheduling with both facilities and canceling the one that cost more. However?like most people, we changed our date and scheduled the surgery for 5 days later at an in-network facility.
Here are some obvious questions that came to mind:
1. Did the scheduler understand how coinsurance works?
2. How can we (consumers) be expected to compare price and service if we are not given access to either before a procedure is scheduled?
3. How many consumers would have accepted that the cost would be the same only to be surprised by a bill for the 30% balance after the surgery?
Now that it's time to pay I'm trying to get the surgery center to identify exactly what we are being billed for. The bill form the surgery center just showed the date of service and an amout owed with no explanation. The EOB from the insurance company shows over $6,200 in charges that are simply labeled "General Ancillary".
I am in the health benefits business. I understand the process and have access to resources that the average consumer does not. I will probably eventually get what I need after I invest some time.
Consumerism, as it applies to all other markets, is not currently applicable to the business of health care at the patient level and that seems to be on purpose.Posted by Mary Orms | Feb 14, 2007 4:43 PM ET
