Tuesday, August 29, 2006
Stress of medical bills
Medical bills.
We dread seeing them, we often complain about them and we really don't want to pay them out of our own pocket.
For years, we counted on insurance paying our medical bills. But with changes in health care coverage today, we often pay a greater share of our medical bills, and we're paying closer attention to them.
"Insurance coverage is the No. 1 concern, more than the medical bill itself," said Colette Lasack, director of patient business services at Gundersen Lutheran Medical Center, which has 1.4 million patient clinic visits and 75,000 hospital registrations each year.
Lasack said medical problems are a stressful time for patients. "They want a great cure, but they don't want to pay for it," she said.
And medical bills can be confusing, but officials at both LaCrosse medical centers say they are making strides to improve the billing process and the actual bills - to make it easier for patients.
The billing process is a medical maze itself Bills are generated as soon as a patient walks in the door for medical care. Most of the information often is sent electronically to the patient's insurance company.
"We then wait for payment from the insurance company, and no bill is sent out (to a patient) until we hear from your insurance company," said Richard Bernard, director of patient financial services at Franciscan Skemp.
New rules under the Health Insurance Portability and Accountability Act of 1996, otherwise known as HIPAA, require that insurance companies have a uniform code system for patient accounting and a standard way to accept claims, Lasack said.
At Franciscan Skemp, patients receive separate bills for clinic, or physician services, and hospital services, Gundersen Lutheran patients receive one bill for clinic, hospital, laboratory and other services.
Gundersen Lutheran sends bills and letters to about 68,000 patients a month. Franciscan Skemp bills about 32,000 patients a month, Bernard said.
Lasack said Gundersen Lutheran's first communication with a patient is an itemized statement - not a bill - sent within 15 to 30 days of medical care.
"We've debated whether to send these out or not, but it tells patients what the actual cost is," Lasack said. "We get a lot of calls because people think it is a bill, but this statement is a courtesy."
Once a patient is billed, if no payment is made on a bill within 120 to 130 days, Franciscan Skemp officials review the account, then send a final notice to the patient before turning the bill over to a collection agency, Bernard said.
"There are lots of opportunities to pay the bill before it gets to collection," Bernard said. "We don't send to collection those who can't afford it, only those who won't pay.
"Once it hits the collection agency, we have nothing to do with the bill," he added.
Lasack said Gundersen Lutheran has a formal financial counseling program to help patients receive Medical Assistance and get loans. "The vast majority want to pay their bills," Lasack said.
Bernard said the number of people unable to pay their medical bills on time has grown because of a slow economy, increasing medical costs and changes in insurance benefits including higher premiums, copayments and deductibles.
"A lot of people struggle, and as long as they contact us and not ignore the bill, most of the time we make arrangements for payments," he said.
Gundersen Lutheran has social workers who work from the start with patients, such as those with cancer, who might have larger medical bills, Lasack said. "We're not going to deny care on the basis that they can't pay their bills," she said.
"But patients need to contact us so we can work something out."
Franciscan Skemp has 3 percent to 5 percent of its patients on a payment plan, Bernard said. Gundersen Lutheran has about 2 percent of self-pay patients on payment plans.
Bernard said technology will continue to change and improve the billing system.
"It makes sense to improve the time the bill gets to the patient and reduce that lag time. That is our challenge."
Lasack said new systems also will improve the readability of bills.
"I'd like to see at an appointment where you get a statement of your charges today,'' Lasack said. "That would help with the expectations of the patients.
"Patients come here for great care, and the last impression they have of this place is their medical bill, so we want to do everything to work with them," she said.
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