Code Green

How Much Do You Pay?

A hospital in northeast Ohio is willing to pay up to $1,000 to patients willing to reveal how much they and their insurance companies paid for care at rival hospitals.

The 192-bed Alliance (Ohio) Community Hospital is using advertisements and its Web site to offer the payments to those who'll turn over documents that detail how much three competing medical institutions charge and how much insurance companies and consumers end up paying.

The offer is part of the hospital's attempt to provide consumers with more information about the comparative cost of healthcare, said Chief Executive Officer Stan Jonas.

Each eligible statement—referred to as an "explanation of benefits"—is worth $100 with a maximum payment of $1,000, the hospital said Monday. — the Associated Press

Hospital Reimbursement Woes Continue

Health insurer WellPoint Inc., starting Oct. 1 will no longer pay for costs associated with 11 medical errors known as “preventable adverse events” and “never events.”

The Indianapolis-based insurer, which operates the national UniCare plan and Blues plans in 14 states, is following the lead of Medicare, which starting in October will not pay for costs associated with eight events.

The purpose of WellPoint’s new reimbursement policy is to ensure physicians and hospitals are using appropriate processes, technologies and strategies to prevent these types of errors.

California drafts rules to regulate emergency room payments

By Kari Kemper, Provider Advantage

The attached article from the LA Times is an excellent example of how confusing the billing process is for patients.  Patients need to know up front (and will eventually expect financial information) the allowable amount for their medical services including carve-out charges that are not in the payers contract with the hospital.  Facility and physician components are required in pricing estimation to educate the patient with a clear view of their out-of-pocket financial responsibility regardless of the hospitals relationship with outsourced physicians and payers. 

California drafts rules to regulate emergency room payments - LA Times