Campbell County Health plans to debut a cost estimator for medical procedures within the next three months for patients in the Gillette area.
The system, called Care Pricer, is for patients and staff and is expected to be available online on the hospital’s website Feb. 3.
It also may help patients who need prior authorization from their insurance companies for certain medical procedures, according to discussions Monday afternoon at the hospital’s monthly finance committee meeting.
“We had a little over $2 million in write-offs last year because we didn’t have prior authorization,” said Chief Financial Officer Mary Lou Tate.
As a result, the hospital is forming a centralized unit to seek approval for medical procedures ahead of time from insurance companies, she said.
Denials have occurred over infusion therapies “because of high-dollar drugs,” and MRIs and CT Scans, Tate noted.
“Last year, we didn’t have a centralized prior authorization,” she added.
At the same time, the cost estimator tool for out-of-pocket expenses will help patients know just what a medical procedure may cost them specifically, based on their insurance.
The tentative online start-up date is Feb. 3, although Campbell County Health trustees likely will be invited to try out the system in demonstrations before that kickoff date.
The cost estimate will ping a patient’s health insurance so it will be specific to that person. It also will cover the technical cost of a procedure, but won’t include professional fees.
The Care Pricer also will let customers know the calculation is just an estimate and may not cover all the costs of a procedure.
“We’ll have to make sure that scripting is really clear,” said trustee Adrian Gerrits
“We hope to go live in February with this Care Pricer implementation. … I can put in that I’m going to have a colonoscopy at Blue Cross, here’s my Blue Cross number ID, and the system can go out and say, OK you have this much out-of-pocket, so this is how much of your deductible, this is your co-insurance and they can give me an estimate as far as how much out-of-pocket I will have,” said Yvonne Robinett, the CCH revenue cycle director.
“The staff also will have access to that. ... If they get prior authorization, they can run a patient’s information through Care Pricer and they can let them know this procedure has been authorized and they can let them know this is their estimated out-of-pocket,” she said. The hospital can then ask patients to pay a deposit on those estimates before or when they come in for the medical procedure.
“That will help that conversation a lot,” Gerrits said.
“Right now it’s hard to collect because it’s like well, we need a $500 deposit or a $200 deposit and sometimes it’s as low as $25,” Tate said. “Patients don’t like the fact that they’re putting a deposit down. They want to know what their personal cost is. That’s one reason we invested in this product, so we can have that financial conversation with a patient.”
The system also will use a lot of claim information provided by the hospital to come up with a common charge for some procedures, Tate added.
That’s why the scripting has to be very clear about the estimates, Gerrits said, “because that’s what people get mad about.”
“Nobody gets upset when we refund them money, but they do get upset if it’s a little bit more,” Robinett said.