Rochester Regional Health (RRH) has added an online aid for its patients who want to get cost estimates for recommended medical services and find out their insurance copays before the medical service is provided.
Tammi Imm, RRH vice president of front-end revenue cycle spoke to the media this week on price transparency and a user-friendly tool on the RRH website. To comply with a 2021 federal law, RRH posts its charges for medical services.
The regulation changes that went into effect Jan. 1 have two components, Imm said. One is that hospitals have to post not only charges for services, but payer-negotiated rates and also have available, through the user-friendly tool, 300 “shoppable” services.
“We want to make sure we have a tool available to our patients and their family members to be able to look up and, ultimately ... price-shop between ourselves and other organizations, utilizing the tool,” she said.
On the Rochester Regional website, https://www.rochesterregional.org/, there is a “Pay My Bill” link users can click on. When someone clicks on that link, there are instructions on how to pay a bill, but on the left side of the page, there is a list of links, including “Price Transparency.”
Under “Charges and Negotiated Rates” on the webpage, there are links to “Hospital Rates” and “Professional Rates” for each RRH facility.
“This is that machine-readable file that itemizes ... every single service and it includes our charge as well as our payer-negotiated rates,” Imm said. “That is one portion of the new regulation and allows folks to, if they desire to do so, go out there and look at that page.”
During the Zoom call, Imm described the “cost estimates’ feature on the webpage.
“We want to be able to offer a price estimator tool to allow patients to plan ahead for what their financial responsibility will be,” Imm said. “We solicit the information that would be needed in order to do so.”
The information RRH patients need to enter includes:
• procedure code CPT or name of service to be performed;
• patient date of birth;
• insurance information;
• phone number; and
• service location.
“When the patient is coordinating with whatever office or department is ultimately rendering that service, they will would be able to provide that information to make sure it’s as refined as possible,” she said of the “CPT or name of service” information. When a patient clicks on “Get Started,” There is a disclaimer at the beginning, partly to tell patients that if there are other medical services rendered beyond the service initially scheduled, there could be additional cost. The disclaimer also includes a cost estimates phone number of (585) 922-COST (2678) and an email of email@example.com for patients to email patient representatives who help with this process.
As a patient continues to the next screen, he or she will see a list of medical services RRH provides.
Patients also have the option to do a search using a CPT code, Imm said. If a patient doesn’t see the specific service he or she wants a cost estimate on, the patient can type a keyword or CPT code into a bar.
When looking up estimates, a patient would first choose the correct insurance. Patients may also choose the RRH service location they’re going to use. The nest screen that comes up provides a cost estimate for a medical service. There is also a cost range for the service.
“This is meant to highlight what could potentially be the range and where you would fall in the range,” she said.
When cost estimates are displayed, the information includes both hospital fees and physician fees.
“We offer a discount for self-pay, and then a surcharge. This is the HCRA (Health Care Reform Act)/Hew York State surcharge. This is, essentially, a tax on health care services,” she said.
Once the fees are added up, a discount is subtracted and the surcharge is added, a patient will know his or her total cost estimate.
Imm said a patient may email the cost estimate information to himself or herself as a record.
“If you put in your email address, it will actually send you a confirmation of this estimate and you will get a reference number,” she said.
Part of getting an estimate on a medical service includes a patient entering his or her insurance information on the website. After clicking on the correct insurance provider, the patient enters his or her information in separate boxes — the patients’s first name, last name, date of birth, member number and group number must be entered and the patient must click “Yes” or “No” on whether he or she is the insurance policy holder.
Imm showed the media an example of what patients would see after they entered their insurance information. Patients would be able to see their copays for the medical services for which they getting cost estimates.