The tool, which doesn't require website registration, allows users to customize their estimates based on the health service they want and their own insurance coverage information.
The ability to make electronic pre-payments is part of a user-generated cost estimator tool from Vanderbilt University Medical Center (VUMC) in Nashville.
Just under four months before the new Centers for Medicare & Medicaid Services price transparency rule is set to go into effect on January 1, 2021, VanderbiltHealth.com has launched an out-of-pocket cost estimator for consumers to get their own estimates for certain procedures.
The online tool generates estimates for certain outpatient services and radiology services, as well as certain inpatient and outpatient surgical procedures.
The tool, which doesn't require website registration, allows users to customize their estimates based on the health service they want and their own insurance coverage information. The tool then retrieves their benefit information. Users can also enter monetary figures for their co-insurance obligation, remaining annual deductible and out-of-pocket maximum, VUMC reports.
Existing My Health at Vanderbilt users have their insurance card information pre-loaded and can save estimates and make electronic pre-payment.
At the December 2019 HealthLeaders Revenue Cycle Exchange in West Palm Beach, Florida, Angela Simmons, vice president of revenue and reimbursement at VUMC, described what she called "guest estimates" for potential patients to self-generate online estimates using their insurance information before they scheduled a procedure.
VanderbiltHealth.com will soon add user-generated estimates for additional services, including physical and occupational therapy visits, certain outpatient services from Vanderbilt Women's Health, and services from Vanderbilt Psychiatric Hospital. It also plans to add user-generated estimates for additional outpatient services.
In addition, VUMC says that 87% of the automated out-of-pocket cost estimates it started sending patients for certain scheduled services last year fall within 5% of the actual out-of-pocket cost, and that they expect that number to improve.
According to Melissa Greer, vice president of revenue cycle at UCHealth in Colorado, the more cases of a service there are, the more accurate cost estimates will be. UCHealth has its own similar price estimator tool and Greer told HealthLeaders last year that it found that providing estimates for low-volume services can sometimes produce a wildly divergent range of possible costs—for example, one case cost a patient $200 and another patient $2,000.
That's why she said UCHealth makes sure that there have been at least 15 cases of a given service at the health system before it's displayed in the tool. The health system also removes the cost outliers at the high and low ends, displaying the whole range except the top 10% and the bottom 10% "because they're clearly not the norm," Greer says.
She also described a dashboard that monitors every estimate and compares it to the ultimate amount that the patient was charged.
Alexandra Wilson Pecci is an editor for HealthLeaders.