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What am I paying? Medical bill transparency and a tool that will help you

Consumers, Cleveland group, president demand more
Customers and President Trump demand more medical bill transparency and now UH has a tool that will help you.
Posted at 7:01 AM, Oct 13, 2020
and last updated 2020-10-13 19:52:24-04

CLEVELAND — Ever feel like you have no idea what your doctor bills are going to cost you? In an effort for transparency in medical costs, local hospitals have put prices online. However, as major federal regulations on costs draw near, a Cleveland research group said so far the price-listings don’t help you the patient.

Howard Barksdale, 69, from Bedford, was driving down the road and got rear-ended in December of last year.

"It’s like a contusion of being hit. My neck was jarred,” Barksdale said.

He said the doctor in the ER asked him to get a CT Scan.

“It’s like anything. You always want to know the price of it. I don’t know why that would be different?” said Barksdale.

He didn’t know the price. He was charged more than $3,900.

“There should be some kind of a clear explanation of what the bill is going to be and how it’s going to be handled,” Barksdale added.

Hospital systems have posted prices in the past for common procedures and lab tests. They list them on their sites. However, the Center for Community Solutions in Cleveland said it’s not enough.

“Prices drive that cost and that transparency is not really an effective tool,” said Loren Anthes, speaking on behalf of the group.

The Center for Community Solutions just recently analyzed health costs in Northeast Ohio. It found list prices for having a baby. For example, they varied from $3,000 at one facility to $41,000 at another. But, even then, those charges are a bit vague.

“Usually list prices don’t reflect what’s actually paid. It’s a matter of negotiation almost on a case-by-case basis,” Anthes said. “We need to fix our system.”

In June, President Trump signed an executive order forcing the hospital system to be more transparent about pricing by Jan. 1, 2021. Now they have to post things like overall gross charges, discounted cash prices, payer-specific negotiated charges, and lowest and highest charges that hospitals have negotiated with all third-party payers…i.e. insurance companies.

“The consumer public is demanding transparency on all kinds of levels,” said Senator Nickie Antonio from Lakewood. She serves on the Ohio Senate’s Health and Human Services Committee. While the Centers for Medicare and Medicaid Services or CMS will monitor complaints if hospitals don’t comply, Sen. Antonio said, on a state level, the legislature could end up educating providers and patients about the new federal regulations. “That provision of care has to be the guiding principle. The care first. The financing of that care second,” said Sen. Antonio.

News 5 asked the big three hospitals —Cleveland Clinic, University Hospitals, MetroHealth– in our area if they see a need to do more with price transparency. The day after our request, University Hospitals unveiled its new UH Hospitals Price Estimator tool.

“It connects the provider, the patient, and the payer to look at specific information,” said UH Chief Revenue Cycle Officer Kathy LeBrew.

The free online tool asks for your insurance company, policy number, name, birthdate and more. Then, you can search for specific lab tests or procedures. In the end, it will calculate your out-of-pocket costs taking into consideration things like deductibles, co-pays and co-insurance.

“Part of this is just doing the right thing for the patient, right? Empowering them with information so they can make informed decisions about their care,” said LeBrew.

She also explained that before making the tool available to all, they tested it on their workers for months.

“Our own employees are patients as well,” said LeBrew. “We leveraged their feedback. We did some re-engineering before we turned it on to the public.”

For patients like Barksdale, who on that December-day accident was just driving to see his longtime girlfriend in the hospital, they say they need all the help they can get.

“It will let you know what you can afford and what you can’t afford,” said Barksdale. “You just don’t go out and buy a million-dollar house when you know you can’t afford it.”

Here is Cleveland Clinic’s response to our transparency questions:

“We have fully complied with the CMS requirement by posting our comprehensive hospital charges list on our website. Most patients do not pay these rates as their specific healthcare plan coverage determines any out-of-pocket charges. For patients to understand their potential financial obligation for care, it is recommended to first check with their insurance provider who has access to all of the detailed information about their personal coverage.

Estimates for care are available to patients when scheduling surgical and diagnostic services and upon request for all other services. We recently updated and expanded our patient self-service module where, either through their MyChart account or through Cleveland Clinic’s website (clevelandclinic.org), patients have the ability to produce their own estimates for 300 services considered shoppable between hospital facilities.

Our financial advocates are also available to help patients understand and calculate their potential financial obligations before they receive care. We provide financial assistance to patients who qualify.”

MetroHealth did not respond to our requests for information.

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