Hospitals to provide more price estimates

May 25--One in a series

Although the process is slow, local hospital systems are working to give potential patients more pricing information up front.

ProMedica has taken steps to make it more convenient to get price estimates before entering the hospital.

The health company has launched an online form that consumers can use to obtain estimates within three days for services at its Toledo-area hospitals.

The online price estimator can be reached at: www.promedica.org/Pages/patient-resources/billing-insurance.

The form is designed to help those get an idea of what final out-of-pocket costs will be with various insurance plans, said Haley Studer, vice president of revenue cycles for ProMedica.

"Our rep will contact the insurance company, look at the benefits, calculate out what it would be, and then give the patient an estimate from there so that they know what they would pay out-of-pocket," Ms. Studer said.

ProMedica also operates a telephone hotline consumers may call during regular business hours to get an estimate.

The telephone line, 1-844-220-0800, has been in operation for several years and receives about 100 calls per week, ProMedica officials said.

The web tool is available anytime, and ProMedica officials said they are working with a vendor to develop a version that would provide immediate estimates.

That version is expected to launch early next year.

To receive an estimate, consumers must enter their names, the type of procedure they plan to have, and the name of their insurance carrier and account number.

Information provided on the form states the estimate represents hospital services only and does not include related fees, such as those for a surgeon, radiologist, pathologist, or anesthesiologist, and that the estimate is subject to change and is not a final bill.

"And that's the challenging part about health-care services. You come in and you don't necessarily know what you're going to run into, so it could be more complicated than what was initially thought or you could have complications from a procedure, so it is definitely an estimate," Ms. Studer said.

Price estimators are one of the best tools available to help health companies become more transparent about their pricing, said David Morlock, chief executive at the University of Toledo Medical Center, the former Medical College of Ohio Hospital.

UTMC is also slowly rolling out its own online price estimator called E Care Next, he said.

Members of the public cannot access the website form on their own, however, said Meghan Cunningham, a UTMC spokesman. UTMC financial-assistance counselors work with patients who have procedures scheduled and use the tool to get an estimate.

"It pulls the most up-to-date information on the patient's insurance plan to provide a specific estimate of the patient's responsibility.

Working with E Care Next there are 135 insurance plans in the system which covers most of our patients," Ms. Cunningham said.

Officials at Mercy indicated they do not now have a way to give patients upfront estimates.

But Mercy Health, the parent company of Mercy hospitals in the Toledo-area, is in the process of creating a central call center that will field pricing questions for all its hospitals across Ohio and in Kentucky, said Sarah Bednarski, spokesman.

"We anticipate this team will 'go live' in the fall of 2015 and will share more at that time of what exactly will be part of the center, what patients can expect, and what services will be available," she said.

These steps being taken by Toledo health companies to provide more information about out-of-pocket-costs are an indicator the local health-care market is catching on to a national movement to make it easier to compare prices.

American consumers are accustomed to comparison shopping for most goods and services, but hospital and physicians' fees were not much of a concern when health insurance companies paid the bulk of those bills, said Richard Gundling, vice president for the Healthcare Financial Management Association.

As consumers are being asked to cover more of their health-care costs through rising premiums, deductibles, and co-pays, they are becoming more price-conscious, said Mr. Gundling, who heads the national professional organization for hospital financial executives.

"As people are increasingly taking on a more significant share of their payment, pricing is moving more into a retail environment," Mr. Gundling said.

The Toledo Clinic was the first area health-care organization to advertise retail prices.

That move has angered other health organizations because its ads contain a chart comparing the clinic's retail price for some common tests and procedures with those of area hospitals. Local hospital executives allege the ads are often inaccurate.

Although Toledo area hospital officials agree the industry needs more pricing transparency, some have been slow to make changes because the health-care price structure is so complex, Mr. Morlock said.

What a consumer pays out-of-pocket for a particular procedure varies significantly depending on insurance status and the type of plan.

"The struggle is, how do you create meaningful transparency for the consumer?" he said.

Some national websites with free pricing web tools seem to have landed on at least one path to greater transparency.

Both healthcarebluebook.com and newchoicehealth.com allow consumers to get estimates on prices for procedures in their area.

Both sites provide estimates in the form of price ranges or, in the case of Healthcare Bluebook, what is called a fair price for the local area.

Contact Marlene Harris-Taylor at [email protected] or 419-724-6091.

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