Price transparency improves for patients on the Lower Eastern Shore

Berlin, Md. – As health plan deductibles rise and the portion of the hospital bill patients are responsible for only continues to increase, the value of price transparency to individuals considering their healthcare options is also rising.

Gone are the days when most insured individuals could expect to pay – and therefore plan for – a flat co-pay for a lab test or an ER visit. Preparing financially for an elective procedure, such as a hip replacement or gall bladder surgery, can be even more difficult.

That’s a key reason Atlantic General Hospital and Health System has launched a price estimator tool for its patients. The calculation takes into account the average cost for the test or procedure in question, the individual’s co-pay and co-insurance responsibilities under his or her health plan and how much of the deductible has already been met.

This service is offered to patients when they schedule a procedure or diagnostic testing or when they check in for their care. Estimate requests can also be made online or via phone by individuals who are considering Atlantic General Hospital and Health System for the care their doctor has recommended.

Patient Financial Services representatives are available 9 a.m. to 4 p.m., Monday through Friday, at 410-641-6448. Requests can be submitted online at www.atlanticgeneral.org/For-Patients-Visitors/Billing-Information/Request-An-Estimate.aspx.

“We’re very excited about being able to offer this service to our community,” said Pattie Stamm, director of patient financial services at Atlantic General Hospital. “We feel being able to provide these estimates helps build trust with our patients and allows them to better plan financially for the care they need.”

Atlantic General has published estimated pricing for the most common blood tests, imaging tests and surgeries on its website since 2011. While helpful, these pricing charts don’t factor in patients’ individual insurance coverage to help them determine what their actual out-of-pocket cost will be.

Healthcare consumers can find themselves bouncing back and forth between their insurance company and the healthcare provider to narrow down the range of what they will owe. Atlantic General’s new service can reduce the steps in the journey to that estimate.

Atlantic General has contracted with a third party, Experian Health, for a secure electronic solution that queries patients’ current insurance information and compares that information with the hospital’s fee structure to arrive at an estimated out-of-pocket cost.

While the estimator tool eliminates a great deal of uncertainty related to cost for patients, Stamm pointed out that it is still an estimate, not a hard figure guaranteed to appear on the bill.

“The base cost for a service is an average, and it can fluctuate somewhat based on the complexity of the patient’s condition being treated,” Stamm said.

One example is the estimate for a routine colonoscopy. While the gastroenterologist is performing the procedure, he may discover and remove suspicious tissue for testing in one patient while another patient is free of such growths and requires no further measures. The cost to the patient will be different. But, the total will come as much less of a surprise.

Atlantic General Hospital and Health System is the first on the Eastern Shore to provide this level of price transparency to patients and the community.

About Atlantic General Hospital

Atlantic General Hospital has been providing quality health care to the residents of Worcester, Wicomico, Somerset (Md.) and Sussex (Del.) counties since May 1993. Built by the commitment and generosity of a dedicated community, the hospital’s state-of-the-art facility in Berlin, Md., combines old-fashioned personal attention with the latest in technology and services. It provides quality specialty care such as weight loss surgery, orthopedics, outpatient infusion for individuals with cancer or blood/autoimmune disorders, retina surgery and a comprehensive women’s diagnostic center. Atlantic General Health System, its network of more than 40 primary care providers and specialists, care for residents and visitors throughout the region. For more information about Atlantic General Hospital, visit www.atlanticgeneral.org.