If you asked American health care consumers whether they’d rather figure out a hospital bill or undergo hemorrhoid surgery, plenty of people would take two aspirins and ask if they can call you in the morning with an answer.
Who could blame them? Hospital bills can be complicated, largely because the U.S. health care system consists of many parts that don’t always move in sync. Even if you go to a hospital in your insurance network, some of the care you receive might be provided by an out-of-network physician. The end result can be a big medical bill that becomes a stressor as you’re trying to heal.
A 2018 survey by a University of Chicago research institute found that 57 percent of Americans have been surprised by a medical bill they expected to be covered by insurance.
But that may change thanks to a new transparency law that went into effect on January 1 requiring hospitals to post the cost of common procedures online.
The hospital price transparency rule is an extension of the Affordable Care Act, which required hospitals to keep a price list. Now, that list must be published online to encourage hospitals to be more consumer friendly and help consumers better understand their potential financial liability for services at a hospital, rehabilitation facility, psychiatric hospital or other similar facility.
This also makes it possible for consumers to comparison shop for a surgical procedure just as they would a refrigerator.
A poll of 150 hospitals conducted by Healthcare Business Insights found that nearly all health care providers are concerned about how their charges will be perceived by consumers.
The new rule is a “step in the right direction,” says Colette Lasack of the University of Kansas Health System. Lasack is the health system’s vice president of revenue cycle operations, which encompass claims processing, payment and revenue generation.
“The worst thing we can do for our patients is give them great health care and then surprise them with the bill,” she says. However, Lasack says that publicizing hospital charges “really isn’t that helpful to patients at the end of the day.”
That’s because patients primarily want to know what their out-of-pocket costs will be, and that figure can differ drastically from the published numbers.
Lasack notes that many health insurance policies are narrowing the number of facilities where you can get full coverage.
“It’s really important to us across the health care industry that we help patients understand their coverage — where to go not only to get the best care but make sure they maximize their benefits,” she says. “Patients understand their car insurance better than they do their health insurance.”
Of course, what a health plan does or does not cover makes no difference to those who have no health coverage. Lasack says she wants to reach out to such individuals to help prospective patients find assistance that might exist thanks to government funding. KU Health System also offers financial assistance for patients and extended payment programs.
“Pick up the phone and call us,” Lasack says. “We’re here to talk to you and help you figure it out.”
In an emergency, you may have no control over which hospital you’re taken to or what kinds of bills you incur. But if you’re scheduling procedures and tests or scoping out hospitals for potential future care, it will help if you arm yourself with information beforehand. To that end, KU Health System recommends you ask your insurance provider some key questions when choosing a hospital:
▶︎ What type of insurance plan do I have?
▶︎ Is the hospital I’m considering in my provider network? If so, does my insurance plan cover physician costs, as well as inpatient and outpatient hospital services?
▶︎ Does my insurance plan cover prescription medications and chemotherapy?
▶︎ What percentage of my bill does my insurance cover?
▶︎ What are my copayments and deductibles?
▶︎ If the hospital I am considering is out of network, does my plan offer access to the hospital through a national referral network?
▶︎ Does my plan have out-of-network benefits? If so, and if I choose to go out of network, what percentage of my bill will be paid by the insurance company? What do I have to pay?
▶︎ Does my insurance plan offer any additional coverage through special networks for treating medical conditions such as cancer?
▶︎ Does my policy have an annual out-of-pocket maximum? If so, will I be responsible for any subsequent charges, other than premiums, after my out-of-pocket payments reach the maximum amount?
▶︎ Before I see a doctor at the hospital, do I need a referral from my primary care physician? Will I need authorization from my insurance carrier?
▶︎ Will I be covered for testing, pathology or radiation charges that may be incurred as part of my initial consultation with a doctor at the hospital?
