Web-based application for patient’s liability estimation in real time to deliver cost-savings

As Consumer directed health care (CDH) plan products continue to gain traction with employers, patient payment as a percentage of out-of-pocket expenses and providers' review will rise further. Health plans are strong proponents of transparency in pricing because of the belief that it is essential to engaging consumers in health decisions. Although providing an estimate on the cost of care before the care begins sound like a relatively easy task, providing real time, accurate patient liability information considering patients' insurance benefits, specific medical conditions and expected care is a lengthy and complex process. There is a need for a solution that not only provides accurate patient liability estimate but also information in real time using a web-based tool. This web-based tool will be a model used for estimating cost of care and member liability at the points of a service, from scheduling to check-out. The solution will generate patient liability estimates in real-time, based on payer specific details, care provider pricing and historical claims data. Let me give an example here. A patient is referred to the healthcare provider for acute abdominal pain experts and stays overnight for some blood work and other medical examination. During the 72 hours of stay, he is repeatedly surprised by visits from not only a gastroenterologist, but a neurologist, a cardiologist, and a psychiatrist. He also undergoes several tests including X-rays and an MRI. These surprises are nothing compared with his shock of receiving a bill of these services. Explanation of his liability of $15,000 after the fact does little to manage the patient’s shock. The need for patient liability calculation in real-time is clear here and urgent for patients and healthcare providers. Patients want to know upfront what charges they can reasonably expect to pay for a medical intervention. Providers also want to know how and when they will be paid. Re: Web-based application for patient’s liability estimation in real time to deliver cost-savings I can totally understand how having this done in real time would be beneficial. There was a time when I visited the doctor and payed $45 copayment per visit. Even after paying a total of $90 for 2 visits, I still got a bill in the mail for $100 which is calculated after the insurance. The doctor’s office said that I still had yet to meet my deductible. I thought this was a bit overkill considering that I was spending a total of $290…what was the point of the appointment anyway? It would have helped me to know exactly my liable price balance without any surprises. I am sure that people with an 80/20 PPO health benefits plan would love to know in real time what their expected costs are before leaving. If a web based tool is going to be considered, then it is important to confirm that the application is heavily tested. This pertains from an IT security standpoint and also from a confidentiality, integrity, availability standpoint. Having the patient data properly protected and costs calculated accurately is necessary for the goodwill and trust of the patient. This should also be applied to dental offices. There have been too many times in which I had to overpay for their “estimated” costs. Then weeks later, I receive my dental insurance benefits statement only to learn now that my dental office actually owes me money for overpayment...sometimes more than $100. It makes it hard to trust some practices because you don't know if this is a common mistake or them trying to milk your wallet. I look forward to an industry accepted application that will help mitigate this concern.