CLEVELAND — Healthcare providers in Ohio will soon have to show you up-front, dollars-and-cents pricing for your care. That’s thanks to a new state law requiring hospitals to post prices for patients.
But another way the law could help you is with health insurance.
As part of our “The Cost of Coverage” series that investigates insurance issues, we went to those who drafted the law here in Ohio to get some answers and spoke to a woman frustrated with her medical billing.
“I feel very disappointed, and I feel like there’s a lack of transparency,” said Becky Schroer from Tallmadge. “My assumption was that that was going to be the amount for hospital services since I received an estimate.”
ANOTHER BILL COME IN AFTER ESTIMATE
Schroer got the estimate for recent care at Summa Health of about $7,500 and paid it ahead of time with $1,500 for hospital services. However, after the appointment, she got another bill telling her she owed an additional $5,100 for hospital services. She was angry.
“I would have rather been billed the full amount up front,” said Schroer. “That would have helped me decide if I actually to move ahead. It was an elective procedure.”
Schroer’s paperwork stated that the estimate is not guaranteed, but she pointed out that this isn’t a couple hundred bucks—it’s more than $5,000.
“It was a lot of work, put all my passion and hard work behind this,” said Ohio State Representative Tim Barhorst, a joint sponsor on the state’s new law that forces providers to list dollars-and-cents pricing and the costs with and without insurance. “By taking the gray out of it and putting the light on it, that will give us a true free market and a functioning market in healthcare,” Barhorst said.
Representative Ron Ferguson is the other joint sponsor.
“We’re the first (state) to have this large-sweeping legislation to guarantee prices for patients,” Ferguson told us.
TRANSPARENCY HELPS WITH INSURANCE QUESTIONS
In light of the recent frustrations with the overall health insurance industry, here’s how the new law can help you. The prices are clear. If insurance companies come back to you asking for more, you can point to the costs in black and white.
“Previously, the insurance company and the patient are just taking algorithms from that 3rd party, from that hospital, and trying to make heads or tails of them,” said Rep. Ferguson. He told us that often, in the scenario, the insurance company sees it one way, and you see it another.
“How do you possibly arbitrate that?” said Ferguson. “And this is going to give us the ability that it’s very clear cut, concise common sense right in front of you.”
Recent Gallup polls showed only 28% of people feel healthcare coverage is good or excellent.
And for Americans’ health problems, cost and access to care are top concerns. When taken together, they outweigh the next six categories combined, which include things like mental illness and cancer.
With this new Ohio law, Barhorst said people will be better prepared.
“There’s still going to be some onus on the patient. You’re still going to have to do your homework but now you have the ability to do the homework,” Barhorst said.
Schroer thought she had done her homework by getting an estimate.
NEWS 5 INVESTIGATORS HELP WITH BILL
After News 5 Investigators connected with Summa Health, Schroer said Summa told her there was an error and she no longer owes the extra thousands of dollars from the second bill.
“When they send you an estimate, the whole amount should have been in that estimate,” she said.
Schroer told us she’s now dealing with a questionable estimate for her anesthesia.
The transparency law is slated to go into effect in early April. Meanwhile, insurance industry representatives have told us they’re reviewing every option they have to fight this law.
LET US KNOW!
If you have had problems with health insurance companies, whether it be denials, delays, surprise billing or whatever it may be, we want to hear from you. Call our News 5 Investigator Tip Line at 216-431-HELP (4357) or email us at InvestigatorTips@WEWS.com.
