Local hospitals offer tools to navigate medical treatment costs

Citizens' Voice, The (Wilkes-Barre, PA)

Jan. 08--How much does heart surgery cost? What about a knee replacement?

Navigating the fine print of health care insurance plans can be daunting, but patients can use tools from local hospitals to help them figure out how much medical treatments cost.

Area hospitals have taken steps to comply with new federal requirements that the Centers for Medicare and Medicaid Services put into effect on Jan. 1. Hospital charges and annual updates must be posted online. Hospital and insurance officials, however, advised these charges may not be the true out-of-pocket costs.

Commonwealth Health posts pricing information for all its affiliated hospitals on the website: www.commonwealthhealth.net/pricing-information, said spokeswoman Renita Fennick.

Fennick said patients want to know how much they personally will pay out of pocket, however, and that is something that a list of charges doesn't tell them.

"It is a difficult issue for patients and providers because hospitals are paid different amounts by different payers and because hospitals can't know in advance the exact cost of care -- especially for complex cases," she said.

Commonwealth Health hospitals have resources available to help patients understand their financial responsibility, including insurance required co-pays and deductibles, Fennick said.

"We accept most insurance available in the community, which will generally determine a patient's out-of-pocket payment that is far less than standard charges," she said.

For patients who have no insurance, carry out-of-network insurance, or who receive services their insurance does not cover, Fennick said Commonwealth Health offers a variety of financial assistance programs, including charity care, prompt pay discounts and "generous" self-pay discounts for uninsured people.

"We also provide eligibility screening services that can help identify the availability of resources to cover medical services such as Medicaid," she said.

Geisinger has featured a "MyEstimate" tool on its website to assist patients with determining possible out-of-pocket expenses for medical treatment.

According to Geisinger, the hospital charges are the same for all patients but they do not include physician charges, which are billed separately.

Barbara Tapscott, Geisinger vice president of revenue management, said patients also can follow up by talking to a financial counselor for assistance or request an in-person appointment.

Kevin Brennan, vice president of provider contracting for Highmark Blue Shield, Eastern Region, said while hospitals posting these costs online is a good first step at more transparency, it does not indicate what the insurance company will pay. There also could be costs for other services that will vary from patient to patient, he said.

With the thousands of lines of billing information being posted online, Brennan said, "I know it would be hard to understand what it's going to cost me."

He said it's difficult for hospital officials to say before a procedure what other variables there will that will affect the cost.

"The problem is it's such as complicated industry and it's very hard to do to get a full picture of what services you're going to require ahead of time," Brennan said. "The level of complexity makes it difficult and challenging but it is important to recognize what the costs of services are and you should have some knowledge and some way to compare."

Pennsylvania Insurance Commissioner Jessica Altman said health care costs are often complex, opaque and depend on the health issue so health systems' efforts to increase transparency is beneficial to the consumer.

She concurred that it's important for patients to recognize, however, that the standard charges listed may not paint the full picture of the true cost of a medical treatment.

"For example, for insured patients, the charge listed by a health system is not the same as the negotiated cost between a patient and his or her insurer, so consumers who are exploring these charges should continue to ask questions, including checking with their insurance plan to determine the cost based on their coverage," Altman said.

Tapscott said with the information provided on Geisinger's website and the "MyEstimate" tool, patients can determine the approximate amount they might owe after insurance. She said it allows patients to be "active participants in their care and make decisions."

"Geisinger welcomes the opportunity to engage in consumer-friendly communication to help patients understand what their potential financial liability might be for services obtained at our hospitals," Tapscott said in a statement. "We are happy to provide guidance and answer any questions our patients may have. We are looking forward to providing more transparency to the public by publishing our list prices and answering questions about individual patient liability through our financial counselors and our MyEstimate tool."

Contact the writer:

[email protected]

570-821-2115, @CVAllabaugh

FIND YOUR COST

--Commonwealth Health posts pricing information for all its affiliated hospitals on the website: www.commonwealthhealth.net/pricing-information. To obtain a personalized estimate for services at a Commonwealth Health hospitals, people can visit the patient access department at the hospital or call a member of the team Monday through Friday at Berwick Hospital Center, (855) 890-3060; First Hospital in Kingston, (570) 552-3900; Moses Taylor Hospital in Scranton, (570) 770-5167; Regional Hospital of Scranton, (570) 770-3168; Tyler Memorial Hospital in Tunkhannock, (570) 836-2161 or Wilkes-Barre General Hospital, (855) 890-3060.

--Geisinger has featured a "MyEstimate" tool on its website to assist patients with determining possible out-of-pocket expenses for medical treatment. Now, patients can access hospital charges at www.geisinger.org/patient-care/patients-and-visitors/billing-and-insurance. Click on "Tools You Can Use" and "Hospital Charge List" and then click on the specific Geisinger hospital used. Anyone who has difficulty accessing the information or has questions can call Geisinger's Patient Service Call Center toll-free at 1-800-640-4206.

--Highmark members who have questions about their services and what they will cost could call the number on their back of their identification card or search the member portal in Highmark's website to find out more specific information about the plan they have.

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