THE HOSPITAL BILL

There are a number of reasons to use hospital services. You might be sent for X-rays by your family doctor. You could need nursing care for an illness you cannot handle at home. You could need emergency services for a broken arm. You could need surgery that is provided by a surgeon who will use the hospital facilities.

Government statistics* show that in 2003, $1,760 was spent per capita in this country for hospital care, about a third of that from private health insurance. Only about 3.2 percent of the spending was out of pocket, the rest from public programs. Still, that 3.2 percent added up to 16.3 billion dollars.

Per capita spending is a significant number. Yet access to good health care is essential to our quality of life, and that does cost money to provide. How can we understand where our health care dollar is going?

The most confusion, explained Dawn Kern, director of the Bigfork Valley business office, comes from not realizing that the medical clinic and the hospital are two different business entities. If a patient sees his family doctor at the clinic, he will be billed by Scenic Rivers Health Systems of Cook, while if the doctor orders lab work, that bill will come from Bigfork Valley.

Occasionally some of the lab work that the doctor has ordered must be done elsewhere. The lab that runs the test will then send a separate billing. The most familiar case of an additional billing is when X-rays are done. X-ray films must be confirmed by a physician specialist who will send his own bill for the reading.

For all the services performed by Bigfork Valley Hospital, the business office will combine the charges and tread the maze of insurance reimbursement for the patient. But in order to do this, information provided by the patient must be accurate and current. In fact, 80 percent of the information that is required to bill insurance companies, Kern explained, comes before the patient receives any service at all – at admissions.

The person or company that is paying the bill receives the itemization of services. But for those who have insurance and still would like to see the itemization, they may call the business office for that information, Kern said.

Although Bigfork Valley will take care of billing the insurance company, the responsible payor is still the patient. However, there are often programs that will help the patient pay his bill that he may not be aware of. The patient financial advisor in the business office can help find programs the patient may be eligible for. Because these may depend on a person’s assets or income, the advisor will need to have the patient’s financial information.

Last winter, Bigfork Valley authorized an uninsured discount program. This applies to patients who have no insurance at all and reduces the bill by ten percent. There is also a Benevolent Care program at the hospital which sets aside a certain amount of funding to cover those unable to pay their bill. Sometimes a payment plan will be possible, with monthly payments set to match the ability to pay.

In the northland economy, family income can sometimes vary seasonally. If an upcoming medical expense can be scheduled, the patient may want to know the probable cost. This also can be answered through the business office.

It is all right to ask about the cost of a proposed procedure. Even Bigfork Valley checks to make sure its charges are similar to other hospitals. “We have done a pricing survey in the last couple of years to assure that we are competitive in the market,” explained Dan Odegaard, CEO.

“As part of our ongoing commitment to care,” said Kern, “Bigfork Valley works hard to help our patients address any financial responsibilities they may have for medical treatment.”

* from health statistic tables on the Centers for Medicare & Medicaid Services page of the Health and Human Services web site.