BILL TRANSPARENCY MBAA 2014

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Bill Transparency
Driven by Consumers
RELATED OPINIONS
BILL TRANSPARENCY MBAA 2014
From charging almost $20 for a
simple pen used to mark a patients
skin for surgery to charging a 500
percent markup for a single over-the-
counter pain reliever (and each
subsequent pill dispensed), the
healthcare industry has its share of
questionable billing practices.

The way many healthcare facilities

remain unclear on the prices they
charge for their services is a major
issue in our healthcare industry today.
This lack of transparency results in a
mess of confusion and frustration
among consumers as well as impressive revenue gains for the facilities in question.

Furthermore, patients are becoming responsible for an increasingly higher percentage of their
own medical costs, and many are becoming aware of this issue and are demanding more
transparency.

This non-transparency isnt limited to complicated issues or treating life-threatening ailments.

Instead, it is affecting people from all walks of life and all levels of physical health for just about
anything we can imagine blood tests, diagnostic imaging, vaccinations - you name it.

Lets say a young, healthy man fell down and hit his head pretty hard after making the game-
winning catch at his familys annual touch football game. His doctor is pretty certain hes fne,
but to err on the side of caution, he decides to go ahead and order a few tests to rule out a
serious injury that could produce delayed effects worse than the major headache hes currently
dealing with.

Now lets say our hypothetical patient gets the CT scan results back and is thankful to fnd out
that his head injury is minor, and hell be fne. A couple weeks later, he gets slapped with a bill
for $900 - his portion of the charge for the CT scan - giving him a different kind of headache.
His insurance paid almost half of the charge, but to him, a bill of that size doesnt seem like any
kind of deal or discount.

The same guy may also take issue with the fact that another patient paid $200 at the same
facility, for the same procedure, and using the same machine. Similarly, patients who are on
Medicaid are often charged on the lower end of the pricing structure.

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Who Does This Afect?
BILL TRANSPARENCY MBAA 2014
So why was our patient charged nearly
$2, 000 ( i ncl udi ng hi s i nsur ance
companys portion) while someone else
was charged 90 percent less? Price
variances for the same services are long
known for having an enormous gap, and
wi thout the consumer demandi ng
transparency, there may never be relief.

Varied costs of diagnostic imaging can be

up to 600 percent at the same facility,
blood tests can vary by 200 percent. One
report even cited that a cholesterol panel
can vary by almost 500 percent in one
U.S. metropolitan area. The report
stresses the fact that the tests are all done
the same, in the same offce with the same level of precision and that the facilities have the
opportunity to charge more in certain cases, so they do.

Although price and quality both vary across the country (and even in the same facilities) they
are not necessarily related. Plenty of high-quality care is received at low prices, and higher
prices do not in any way indicate high quality.

TransUnion Healthcare surveyed 7,500 people and reported that pre-treatment costs are not
being provided each time patients ask for them. In fact, only about 25 percent of patients claim
to have received pricing while many more actually requested pricing before undergoing any
type of procedure.

Typically, providers arent upfront regarding costs. Heightened frustration over this lack of
transparency is leading to more noise among consumers and an ever-increasing demand for
this issue to be brought to the surface and set straight.

Dave Wojczynski, Sr. Vice President at TransUnion Healthcare, said that contracts drawn up
between healthcare providers and insurance companies have kept prices hidden from
consumers. Such agreements are loaded with hitches and gray areas, which only complicate it
more for the consumer.

Furthermore, it is unlike the freedom consumers have to compare prices when shopping for the
best deal before making purchases. Many just have to stick with what they get where they are
sent.

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The Consumers Voice
BILL TRANSPARENCY MBAA 2014
Patient satisfaction, which is a large part of Obamacare, matters more to many providers now,
and Wojczynski says that they are defnitely speaking their voice on patient satisfaction.
Providers will want higher satisfaction ratings with patients, which, according to the report, are
affected by price transparency.

"We defnitely have a correlation between the billing experience to the patient, and how it
affects their overall experience in terms of customer satisfaction," Wojczynski said.

It has been noted that the Department of Health and Human Services could use their authority
to pass a law giving all Americans the right to know the exact cost of their own healthcare, but
Wojczynski believes that the consumers (not some mandate) are the ones that will initiate these
changes by continuing to voice their opinion on the issue.
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We denitely have a correlation between the
billing experience to the patient, and how it
afects their overall experience in terms of
customer satisfaction.
- Dave Wojczynski
BILL TRANSPARENCY MBAA 2014

Even though most facilities are aware of the consumers desire for price transparency, half of
those surveyed still said their bills left them perplexed. Almost 70 percent said that they were
stunned by the costs, and almost the same amount of people said they want to know what the
actual cost of healthcare is (including the portion their insurer covers). The remaining
consumers (about 30 percent) reportedly only want to know what their portion of the bills
would cost.

Also, the majority of those surveyed (over 80 percent) said it would be either helpful or
extremely helpful if they knew what the expenses would be in advance. Imagine all of these
individuals speaking up. The facilities would have no choice but to listen.

If insurance companies wanted to get on

board to support price transparency,
they could start by snubbing any
agreement with a facility that included a
gag clause, which is a part of the
contract that would prohibit price
disclosure to the patient.

Whether or not insurance companies

would get on board is unknown as they
face their own complicated web of
agreements with hospitals. But since the
premiums they charge are part of the
refection of what they pay out, they may
have some incentive of their own.

Consumers could also reject any plan or service that did not offer the option to receive
estimates for treatment ahead of time. It stands to reason that if you take a car in for repair, you
want an estimate before they start services. So why would your own healthcare be any
different?

One report recommended demanding volume and outcome data from insurance companies
and Medicare to give consumers more fexibility and the chance to view and go for lower-cost
or higher-quality providers.

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Strength in Numbers
The Data
BILL TRANSPARENCY MBAA 2014
Den Bishop, chairman of a consulting company advocating for decreased healthcare costs,
warned people to avoid having a heart attack near Covenant Medical Center in Lubbock,
Texas, because they charge over 400 percent what the Lubbock Heart Hospital charges.

Another warning by Bishop said, We cant have a system that caps what one side of the
economy pays while the other is completely exposed in a non-transparent environment. We
have to get to the point where we know price and quality.

Bishop suggests that consumers be proactive and communicate ahead of time with their
health insurance company to avoid the sticker shock that comes with so many medical bills.
He also warned against being fooled by what he referred to as reverse incentives.

This occurs when a patient is sent to a place that charges more money and then is given a
discount, making the patient feel as if he or she just got a great deal.

This is the equivalent of a local apparel retailer infating prices and then offering a discount off
of the higher price. Consumers are lead to believe they got a great deal, when in all actuality,
they paid more than they would have elsewhere. Bishop said, The system has caused us to
focus on discounts rather than what we really pay for services.
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Call 855-203-7058 or Click the Button to Visit BillAdvocates.com
Looking to Dispute Medical Bills?
We cant have a system that caps what one side
of the economy pays while the other is
completely exposed in a non-transparent
environment. We have to get to the point
where we know price and quality.
- Den Bishop