A few years ago, I was referred by my doctor for an imaging exam at the nearby hospital that he was affiliated with. I was given a script and instructed to contact the hospital to be scheduled. Having worked at an outpatient imaging center in the past, I knew I had options for medical imaging—specifically, whether to go to the hospital or an outpatient imaging center. And my experience in medical informatics has taught me that health insurance coverage is complex, and I should find out what something will cost before I schedule my appointment. So I started my search.
- I contacted the hospital to find out what it would cost me for the exam. They advised me to contact my insurance company.
- My insurance company informed me that I needed to get the CPT code, or Current Procedural Terminology, from my ordering physician.
- I then contacted my ordering physician’s office, which gave me the CPT code.
- After reconnecting with my insurance company, I was informed that they also needed the ICD code (International Classification of Disease, aka: reason for the exam).
- I contacted my ordering physician’s office, which gave me the ICD code.
- After calling my insurance company (for the third time, but who’s counting!), they let me know I would owe my full deductible of $1500 at the time of the exam, and then they would cover a percentage of the rest of the charges. They then advised me to contact the hospital to find out the total cost.
- Once again, I contacted the hospital and gave them the CPT and ICD codes. Only then was I able to find out that the total cost to me would be $1560 for the exam.
As you can imagine, I was not about to take a $1560 hit without ensuring that I knew all of my options. I contacted an outpatient imaging center nearby to find out what the cost would be to have the study done at one of their locations. Total cost to me: $50. That’s it. Fifty dollars out of pocket because of the type of service and the contracted rate with my insurance company.
I was shocked and had many questions, but the two that stand out most in my mind were:
- Why is there such a drastic difference in my payment responsibility when it’s the same exam at either location?
- Did my doctor realize there would be a significant cost to me when he referred me to the hospital for imaging?
I made one more call to my physician’s office to make sure they had no issue with me going to the imaging center versus the hospital. They said it was my choice, so guess which option I picked?
Having worked in the radiology sector for more than 15 years, and having some knowledge of contracted rates and service-based locations, I clearly had an advantage. I knew to consider an outpatient center for my exam. But many patients don’t realize they have options, nor do they have the time to track down this information or shop for the best circumstance.
Too often, patients find themselves with sticker shock when they arrive for an imaging exam, not knowing in advance the cost they are ultimately responsible for, regardless if they have insurance coverage or are self-pay. And the doctor’s primary interest is in where you can have the imaging performed that will return the results and images to them in the quickest, most ideal format.
The healthcare industry has seen so much hype regarding the “patient-driven experience.” But what does that really mean? At Fujifilm, we believe that a patient-driven experience means delivering care and services when, where, and how patients want them. With the rise of healthcare consumerism, patients are realizing they have choices when it comes to care (and if you didn’t know, let my personal imaging story be proof point number one). And one important factor when shopping for services is common to everything we shop for—what will this cost me in the end? Unfortunately, finding that answer is not always straightforward or easy.
Today’s healthcare organizations are seeking to put patients at the center of their business model by becoming more proactive and transparent throughout the patient’s care experience. And with the right technology, these organizations can also find ways for staff to experience streamlined and automated workflows, which allows them to spend more time focusing on patients rather than processes.
Our Synapse® Enterprise Information System (EIS) version 7 platform is a perfect example of this. We recently added a number of new features and functionalities that specifically aim to make patients’ (and staff’s) lives easier, things such as remote appointment scheduling, automated appointment communications and pre-registration, payment cost estimates and payment plan options, virtual and contactless check-ins, and alerts that notify patients when their exam results are ready for viewing. We know that these are the types of tools patients want, because ultimately, we’re patients too. And in today’s consumer-driven world, putting patients in the driver’s seat is the way to keep healthcare businesses moving forward.
For more information on Synapse EIS v7.0, contact us here.