To 'comparison shop' health services, answer three questions

Published on Friday, March 1, 2019

By: Bruce Coleman

Note: This story appears in the March 2019 edition of CONSULT, the monthly e-newsletter published by the UMMC Division of Public Affairs that focuses on cutting-edge clinical advances, innovative educational programs and groundbreaking research occurring at UMMC. To receive CONSULT in your email, visit www.umc.edu/CONSULT to sign up.

The online price transparency requirement for hospitals triggered by the Centers for Medicare and Medicaid Services Jan. 1 as mandated by the Affordable Care Act has encouraged patients to “shop around” to find the best value for certain health care procedures, supplies and medication.

Yet the list prices now published on hospital web sites don’t take into account all of the factors that could impact a patient’s actual out-of-pocket expenses – such as insurance status, time of year the procedure is to be scheduled and which provider would perform the procedure, among others.

According to Robert Douglas and John Wilson, directors of hospital revenue cycle at the University of Mississippi Medical Center, consumers shopping the Internet seeking the best health care deal should remember that time-honored Latin phrase, caveat emptor – buyer beware.

For many years, financial counselors at the Medical Center have provided – and continue to provide – cost information directly to patients via telephone communication to help them determine the best value for their needed procedures. “UMMC now has all of its prices published online so we are compliant with the Medicare mandate,” Douglas said.

“The only procedures we would not be able to give information on are those that insurance companies deem to be experimental and those the companies will not cover,” Wilson said.

“But if health care consumers want to better understand their out-of-pocket costs – even if they want to cost compare to other hospitals – they need to know some important information first,” Douglas said.

The pair offer the following tips to help savvy consumers determine an “apples to apples” hospital price comparison to get the best quality care at the cheapest possible cost:

• Know who your insurance carrier is and what your benefits are.

“A patient’s out-of-pocket costs will be influenced by the contract their insurance carrier has signed with the hospital providing care, and by what procedures their individual insurance plan allows,” Douglas said. “The amount of deductible and coinsurance they must pay is determined by the specific benefits and plan they have with their insurance carrier.”

Wilson said consumers who contact financial counselors at UMMC have an advantage because they don’t necessarily have to know all of their benefits – just who their insurance carriers are.

“While the counselor has the patient on the phone, they can log onto the insurance provider’s website to verify their benefits,” he said. “They can determine how much of the deductible has been met for the year or if there is coinsurance that will have to be paid.

“We also provide an educational piece. We explain the services UMMC offers to help them understand their bill, their charges and what they have to pay.”

• Know if your physician and hospital are in network with your insurance.

When a patient’s insurance carrier has a signed contract with the physician providing care and the hospital where the care is to take place, both the physician and the hospital are considered to be “in network” with the insurance carrier. If a contract is not in place, the physician and the hospital are considered to be “out of network.”

“Determining which hospital offers the cheapest price is a nice bit of information, but it can be useless if the patient’s physician that is providing the care, and the hospital where the care is taking place, is out of network,“ Douglas said.

He said patients of UMMC physicians have an advantage on this point as well.

“Physicians at the Medical Center are employed by UMMC and most contractual agreements we have with insurance carriers cover the physician providing the service, as well as the UMMC hospital where the service is provided. This is true of our Grenada and Lexington facilities and physicians as well. 

“For patients who do not have a UMMC physician, they may want to ask their physician what hospitals they have privileges to provide services at so they can ‘shop compare’ between those hospitals.”

Douglas said he advises patients to check with their insurance providers to make sure the hospitals being considered are “in network” and procedures at those facilities are eligible to be covered.

“As long as the hospitals are in network with their insurance and their physician has privileges to perform services there, patients should feel free to compare the prices of those hospitals,” he said.
   

• Know when the procedure is to take place.

It does little good to determine prices in December for a procedure that won’t be scheduled until January, Wilson said. For most insurers, the “deductible clock” resets at the stroke of midnight on the first day of the year, and the price estimates obtained the previous year may have changed dramatically.

“When we provide a price estimate, we let the consumers know that it can change,” he said. “If they call me on Dec. 16 and ask what a procedure costs, it could be completely different if you have that procedure after Jan. 1 because all the copays and insurance resets.        

“Our estimator team’s goal is to be better than 95 percent in our accuracy. That’s how we measure our performance on a weekly basis.”

For now, Douglas and Wilson suggest the best way for consumers to get the most complete information to help make the most optimal health care decisions is to put down the mouse and keyboard and pick up the telephone.

“If you’re coming to UMMC and you want to know how much you’re going to pay for care, the first thing you should do is call the financial counselor’s office and get an estimate,” Douglas said. “You just need to know who your insurance carrier is and the procedure you are going to have, and we can get all the information on pricing you may need.”

Wilson said financial estimators at UMMC can also help patients determine the best way to pay for any procedure they may need.

“The estimators work with patients to set up payment plans and collect partial down payments to get the procedure on the books,” he said. “For self-pay patients, health benefits coordinators will see if the patients qualifies for any type of insurance or find out if they may qualify for Medicaid. If they don’t qualify for anything, the health benefits coordinator will see if they qualify for our financial assistance program.”

When comparing prices, Douglas said it’s important to understand the Medical Center’s unique role in the state of Mississippi.

“UMMC is the only academic medical institution and Level 1 trauma center in the state. When comparing our prices to other hospitals across the board online, they’re not going to be the same.

“UMMC treats the most severe and complex health needs; therefore, our prices are more comparable to those of other academic medical centers across the country than those of health care providers in our local market.”

To see the Medical Center’s online prices, click here. UMMC patients also can ask questions about pricing via MyChart. To speak with a UMMC representative about pricing, call the Guarantor Services Department at (601) 984-6650.