Officials say price lists ineffective in rural hospitals

Feb. 09--A new regulation in the Affordable Care Act went into effect January 1st this year and is not helpful to rural hospitals or patients, according officials at area hospitals.

According to the Affordable Care Act, hospitals are required to publicly list standard charges for items and services. In order to comply, local hospitals have posted extensive looking, yet very non-consumer friendly lists in a spreadsheet format. They are often tucked away in the website, several clicks from the home page in a downloadable document.

Officials said the lists are ineffective anyway -- especially in rural hospitals.

For rural patients extra travel costs, waiting time and insurance charges make shopping around for medical care less convenient. Patients tend to stick with people in their community that they know personally.

In addition, when you factor in some insurance company requirements, the listed prices and standards are ineffective fro the start -- especially at rural hospitals.

Juana Lujan, junior executive at Harper County Community Hospital in Buffalo, said patients don't use that list. They either come in or call the office to get a quote.

Insurance companies are also a factor.

"I know some insurances made it now to where if you have a big procedure like a CAT scan or MRI, you have to call your insurance and they will give you the available locations that you can get that procedure done, and if you do not call, as a patient you get [charged a] $100 fee," Lujan said.

The way and language required for the price lists are another issue.

"Unfortunately the guidelines are very specific about the format in which the information is required to be presented. It is a concern that the average layperson would have a difficult time finding the information that they needed and understanding it in light of their current medical coverage or lack thereof," said Joey Burgtorf, M.S., CCC-SLP, Newman Memorial Hospital (Shattuck) director of health information management.

Rather than leave the confusing list for patients to muddle through, she said hospitals in this area go above and beyond with personal service.

"Office employees are available to help patients understand their charges and how they will apply to their specific circumstances," Burgtorf said. "These circumstances include whether or not they have insurance coverage, the type of insurance plan they have selected, the allowable charge dictated by that insurance plan, their co-payment and deductible amounts."

Meaningful comparison among providers about a patient's out-of-pocket costs are almost never reflected in standard charges, much less what the hospital is actually paid, according to Director of Marketing at Alliance Health in Woodward Douglas Ross.

According to Ross, hospitals are paid different amounts by different payers, including insurance companies and government agencies. The exact cost of care depends on individual and sometimes complex cases which hospitals can't know in advance.

"For patients who have no insurance, carry out-of-network insurance, or who receive services their insurance does not cover, we offer a variety of financial assistance programs, including charity care, prompt pay discounts, and self-pay discounts for uninsured individuals," Ross said.

Rural hospitals and patients tend to understand the flexibility needed to be prepared for the unexpected and unforeseen. While it is nice to know a ball-park price upfront, things can change quickly based on circumstances or individual needs.

"It can be very difficult to know in advance the total cost that will be incurred during an evaluation and subsequent treatment. The basic charges can be looked at up front, but there is always the potential for unanticipated factors to occur. During an evaluation and/or treatment, the first priority always has to be to provide each patient with comprehensive, compassionate care," Burgtorf said.

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