When patients (and healthcare providers) get their bill from the hospital, there are a number of things about it that just feel wrong.
For starters, people don’t know how much they’re paying until they get the bill—something that would never fly in any other industry. Imagine signing the papers to buy a car or a home, sight unseen, and then after you’re presented with it, get surprised with the bill.
That’s exactly how hospitals work.
And once the bill finally comes, it’s frustratingly devoid of details or justification for the prices given. Patients and health insurance providers are expected to take the bill at face value, without question.
Americans’ overall trust in the healthcare system continues to erode, due in large part to hospitals’ inconsistent and unexplainable pricing structures.
Back in 2013, the federal government public a massive database of healthcare costs, shocking the populace and revealing widespread discrepancies in treatment pricing.
The database shared that treatment for chronic obstructive pulmonary disease (COPD) costs nearly $100,000 at Bayonne Hospital Center in New Jersey, while the Lincoln Medical and Mental Health Center charges only $7,044 for the same treatment just 30 miles away.
It’s no better on the West Coast, either. USA Today reports:
“The cash price for a lower-back MRI without dye ranges from $475 at the Castro Valley Open MRI to a whopping $6,221 at the University of California, San Francisco at Mt. Zion.”
At one hospital, the average cost to insert a permanent pacemaker ran a little more than $60,000 in 2011. Meanwhile, at another facility less than a third of a mile away, the same procedure costs more than $127,000.
The Washington Post zeroes in on their town, too:
In the District, George Washington University’s average bill for a patient on a ventilator was $115,000, while Providence Hospital’s average charge for the same service was just under $53,000.
For a lower joint replacement, George Washington University charged almost $69,000 compared with Sibley Memorial Hospital’s average of just under $30,000.
We could go on and on with the various examples. They’re everywhere.
Jeffrey Young and Chris Kirkham of The Huffington Post shared the far-reaching problems associated with the price differences:
“These price differences impose a uniquely punishing burden on the estimated 49 million Americans who have no health insurance, experts say. They are the only ones who see on their bill the dollar amounts listed on these official price lists. Yet these same prices effectively shape what nearly everyone pays for health care, because they determine how much private health insurance companies must surrender in reimbursement for services. That in turn influences the size of the premiums that insurance companies charge their customers.”
So what is a corporate healthcare benefits manager to do about such drastic inconsistencies?
Enter Captiva Benefit Solutions. In order to control costs, you have to have a clear expectation of what the providers will charge. A transparent price must include the full bundle of services that wrap around it.
Having absolute assurance and agreement on what comes with the price, as well as tackling fraud and ensuring claims are paid correctly, is essential to keeping costs down.
Through the Health Rosetta paradigm providers (typically independent imaging centers, specialty hospitals, and ambulatory surgery centers) supply up-front pricing at significantly reduced rates in exchange for increased volume, quick pay, reduced friction, and avoiding claims/collections problems–all factors that allow providers to charge greatly reduced prices while netting a similar amount to standard insurance billing.
Providers contract directly with an employer or a third party aggregator to offer services outside of a typical payment and network structure. In exchange for significantly reduced rates, employers encourage plan members to use these providers, typically by waiving all of the individual’s costs including copays, coinsurance, and deductibles.
You don’t need a massive data dump from the government to find a fair price for hospital treatments. You just need Captiva Benefit Solutions.
Our expertise and bargaining power will neutralize the incongruences of hospital costs and give you numbers you (and your employees) can work with. Call us today.