Modern insurance plans — and, indeed, cases where people remain un- or under-insured — mean that whenever possible, healthcare consumers want to be able to anticipate potential costs as accurately as possible. This is the dawn of “retail healthcare” when it comes to certain anticipated, nonemergency cases, and consumers have a growing array of resources at hand to shop around.
For example, MagicValley.com is featuring a multipart series that helps consumers learn the language and functions of healthcare billing, the better to be prepared to comparison shop.
But even the best-planned medical procedure can create sticker shock, as can be seen in NPR’s Bill of the Month: Estimate For Cost Of Hernia Surgery Misses The Mark. In this case, the consumer in question did his homework so he and his family could prepare and budget for planned hernia surgery — only to learn when the bill came that they and the hospital had vastly underestimated the dollar amount for which he would be responsible:
All the estimates the Balzers had painstakingly obtained were wildly off. The hospital’s bill was $16,314. After the insurer’s contracting discount was applied, the bill fell to $10,552, still 51% over the initial estimate. The contracted rate for the surgeon’s fee was $968, more than double the estimate. After Cigna’s payments, the Balzers were billed $2,304.51, much more than they’d budgeted for.
“This is ending up costing us $800 more,” said Farren, 36. “For two working people with two children and full-time day care, that’s a huge hit.”
The hospital ran the code through a computer program that produced an average of what others have paid in the past, but it was either short on data or did not possess the sophistication to provide an accurate estimate. Fortunately, there was a happy ending for the patient:
After a reporter made inquiries about the discrepancy between the estimate and the billed charges — six months after they got their first bill — Pugliese told them to forget it. Their bill would be an “administrative write-off,” they were told.
Generally speaking, there is no recourse for the patient in this kind of situation, although patients are known for complaining about their bills and providers do adjust in certain situations. No healthcare provider can afford to make a habit of this, however! Those best equipped to analyze and thereby anticipate segmented expenses will provide the most favorable conditions for persons shopping for healthcare, whether it’s a hernia operation of any of dozens of nonemergency treatments and procedures.
The EOB service line data is a benefit on the reconciliation for the patient. Being able to extract the data and present it to the patient in a more easily readable, online format, adds value to the patient experience.
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