The Lincoln Herald recently received a Letter to the Editor from a reader who expressed concerns about the different costs of healthcare procedures at different locations in our area. We asked for and received the following response from Atrium Healthcare.
Thanks for the opportunity to address your reader’s question.
Healthcare delivery is an extraordinarily complex, heavily regulated business that requires contracts with thousands of partners, suppliers, manufacturers and private sector insurers, as well as Medicare and Medicaid.
As your reader notes, our website features a cost estimator tool. Using specific information input by the patient, the tool can convert hospital and insurance data into a rough estimate of the out-of-pocket costs a typical patient can expect for many common services and procedures. It’s important to note that the estimates are only hospital charges – they do not include physician charges. Plus, your doctor will make decisions during a procedure about unique complexities that may arise while delivering service, including any unforeseen complications which may also affect your out-of-pocket costs.
As people attempt to use this tool to compare costs, it’s also important to note that there are thousands of variables that exist in determining someone’s actual out-of-pocket cost. Our data file contains over 30,000 chargemaster items and more than 20,000 medical code numbers for more than 50 payer-contracted rate schedules per hospital. So, where your treatment takes place matters. Costs will differ between treatment provided in a clinic, compared to a hospital or within a hospital emergency department, for example. Different hospitals within the same system may also have varied costs based, in part, on the level of services each are capable of providing.
Every employer-sponsored plan is also different, affecting deductibles, out-of-pocket maximums and exclusions – combined with uncertainty on how much has been paid towards an individual or family deductible – all of which is essential information in determining an accurate estimate of what a patient may be responsible for paying.
The cost estimator tool factors in many elements of historical data to derive the estimates and we recognized earlier this year that estimates generated for Atrium Health – Lincoln needed to be adjusted to provide more accurate and current cost estimates. We implemented revised charging tables in April and we are working with our vendor to ensure the tool is now averaging in the current table to return more accurate results, and ones that better estimate the actual costs a patient would incur in Lincoln or at other facilities within our system.
At Atrium Health, we believe it is important for patients to understand the costs associated with their care. We always encourage patients to talk with their provider ahead of time and ask any questions about the cost of care or treatment for the most accurate and up-to-date information.
Lincoln Herald addendum: Atrium still didn't directly and concisely answer a couple of questions we posed in asking for their response. We wrote (last Monday): I appreciate your response, but it still doesn't specifically answer a very important question the writer of the letter prompted: Do the same procedures cost more (or less) at one Atrium facility than another? Are rates higher in Lincolnton? I will wait to publish the LTE un to give time for a response from you (Atrium) which I will publish the same day. I think that's fair.