Beacon Journal: Patients can get $100 to reveal hospital bills
From John Curry, April 16, 2008
Subject: Canton area retirees...wanna' make $100 by sharing your hospital bills and Medical Mutual's/AultCare's payments or lack thereof?
Alliance Community offers to pay for statements, will use data so public can compare medical costs
Alliance Community Hospital wants to pay you $100 or more to find out how much your health insurer paid for care you received at rival hospitals.
The hospital announced on Monday that it wants patients from Mercy Medical Center in Canton, Robinson Memorial Hospital in Ravenna or Salem Community Hospital to hand over their bills and corresponding ''explanation of benefits.''
These EOB statements from insurance companies detail how much medical institutions charge for procedures and treatments, as well as how much insurers and consumers actually end up paying.
Patients who are insured by companies such as Cigna, Anthem, Medical Mutual, UnitedHealthcare, AultCare or SummaCare can receive a $100 ''donation'' from the nonprofit Alliance Community Hospital for every eligible EOB statement, for a total of as much as $1,000, according to the hospital.
Alliance Community Hospital Chief Executive Stan Jonas said the offer is part of the hospital's attempt to provide consumers with more information about the true cost of medical services.
The hospital plans to share the information eventually on a new Web site.
''We feel that consumers should be able to compare prices before they buy health-care services,'' Jonas said. ''We are doing this because we want to prove our value in the marketplace and to provide meaningful comparisons with our own pricing, as well. So in order to help inform consumers, we are seeking information about procedures performed at other hospitals.''
The American Hospital Association isn't aware of any similar initiatives at any other hospital nationwide, spokeswoman Elizabeth Leitz said.
But, she added, ''hospitals are trying to be more transparent with our community about the price of health care.''
At least one insurer is raising concerns.
''To the best of my knowledge, this appears to be a new type of initiative,'' said Richard Waldron, director of provider networks for Medical Mutual of Ohio. ''While we support the concept of transparency, this initiative seems problematic. Looking through EOBs from unrelated facilities poses issues of data collection, interpretation and validity. Moreover, there may be numerous legal issues inherent in such an effort.''
However, Mike Bernstein, spokesman for Akron-based SummaCare, said the EOB statements belong to the patients, who can choose to share them.
''The EOB is the property of the patient, and we have no concerns if they choose to share it publicly,'' Bernstein said.
The Alliance hospital is seeking patient insurance statements from 2007 for inpatient stays, emergency room visits, MRI and CT scans and physical therapy.
Patients are asked to black out personal information, including names and Social Security numbers.
Interested patients can call the billing office at 330-596-7556 ''to set up a brief interview with an ACH professional to determine if your EOB information qualifies,'' a hospital statement said.
Increasing transparency
In recent years, ''transparency'' has become a buzzword in the medical industry as patients are being forced to foot a higher percentage of the bill.
The Centers for Medicare & Medicaid Service's Web site, for example, includes average Medicare payments for some procedures, as well as results from patient satisfaction surveys and other quality indicators.
Hospitals also are required to publicly share the prices they charge. But the discounted rates that insurers pay and the out-of-pocket share footed by patients often are difficult to obtain.
''We want you to comparison shop for your health care in much the same way you do for other major investments or capital expenditures in your personal or professional life,'' Jonas said.
Alliance Community Hospital is independently owned but has an affiliation with Aultman Hospital of Canton and other hospitals in Orrville and in Holmes and Tuscarawas counties through the Independent Hospital Network.
Hospitals respond
When told about Alliance Community Hospital's initiative, Mercy Medical Center issued a statement on Monday indicating that the Canton hospital already shares pricing and quality information and ''supports educated, informed consumers.''
'' . . . Quality and pricing reports are just one tool for consumers, who should also talk with their physicians and check their health insurance coverage when making choices about their health care,'' the statement said.
Officials at Robinson Memorial Hospital ''do not have any concerns about patients voluntarily sharing our contract rates because we provide low-cost, high-quality care to our patients in Portage County and beyond,'' said Carl Ebner, the hospital's vice president of finance.
''We believe in transparency and have no qualms about sharing our prices.''
Ebner noted, however, that federal regulations and contract terms forbid hospitals themselves from telling competitors the payment rates they negotiate with insurers.
Cheryl Powell can be reached at 330-996-3902 or chpowell@thebeaconjournal.com.
[Gee, I think that's twice what my parents paid when I was born in that Alliance hospital (well, the old one, not the beautiful new one they have now). KBB]
posted by Kathie Bracy at 3:37 PM
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