LEE COUNTY – Patients of physicians, clinics, and services provided by Great River Health Systems could be looking at some sticker shock for services provided after Aug. 1 of this year.
The predominant hospital system of southeast Iowa announced a change to its billing protocols with services beginning on that date. Great River Health is the umbrella company of Southeast Iowa Regional Medical Centers in West Burlington and Fort Madison, among 21 other clinics in Des Moines, Henry, and Lee counties.
According to an announcement from the health system on Monday, Southeast Iowa Regional Medical Center Clinics - in West Burlington and Fort Madison, and Henry County Health Center Orthopedic Clinic, now follow a provider-based or hospital-based billing model for outpatient services.
Provider-based refers to the billing process for services received in a hospital-owned medical practice that is a clinically integrated department of the hospital, or outpatient clinics that are actually part of the hospital.
Officials said last week in an emailed statement to Pen City Current that the provider-based billing is the national model of practice for healthcare organizations that provide both hospital and physician services to their patients.
“Southeast Iowa Regional Medical Center is taking proactive steps to ensure high-quality care remains available to all of our patients. We strive to maintain a high level of physician services in our communities. By converting to a provider-based billing model, Southeast Iowa Regional Medical Center is ensuring it is reimbursed fairly for services it provides,” the statement indicated.
The information outlined how healthcare services received after August 1, 2024 will show two charges billed separately, even though they may happen at the same time. These charges include professional services or doctor care; and a separate charge for facility fees related to the clinic or hospital resources used.
Professional services cover being seen by a healthcare provider, or a test result read. Facility fees or hospital care cover room usage, equipment, supplies, and any additional healthcare staff involved in a patient’s care during their visit or procedure. Any labs, tests, or imaging done during the visit would also be expenses you may be responsible for. Your insurance plan coverage will be applied to both bills and the remaining balance will be billed to you. The health system is recommending that you consult directly with your insurance company to find out which portion of your charges will be covered under the new system.
Pen City Current and Great River Health had set an interview for Monday, Sept. 16 to discuss the changes and its local impact, but that interview was canceled an hour before the interview was to take place and all questions were asked to be emailed for a response.
At the same time, a press release was emailed to all local media outlets outlining the changes that went into place six weeks ago.
An email with responses to questions from Pen City Current about the changes outlined the new structure.
The billing structure doesn’t address how copays will be applied to bills accrued after Aug. 1 and a hospital spokesperson said copays are under the purveyance of insurance companies.
“Co-pays are established by the insurance plan the patient is covered under. If the patient’s insurance plan requires that they pay a co-pay, we would accept it,” the spokesperson wrote. However, they didn't specify if the co-pay would cover the same costs traditionally covered by a co-pay.
“If the patient’s insurance plan does not require that they pay a co-pay, then we will not be accepting one.”
The official said annual wellness exams are still covered as they were before up to the point that a patient discusses concerns that need further attention or testing.
“These will be billed accordingly. Preventative screenings like mammograms should see no changes in how they are billed.”
The hospital also said the change doesn't necessarily mean most patients will be seeing increased costs on a regular basis for routine hospital visits that traditionally would be covered under co-pays.
“Not necessarily. The impact on costs will vary depending on the patient’s insurance plan and coverage,” the spokesperson wrote.
“While provider-based billing may result in separate charges for professional and facility fees, insurance plans often cover these differently. Some patients may see increases, while others may not experience a significant difference. We encourage patients to consult with their insurance providers to fully understand how their coverage applies under this model.”
Some states are starting to create and sign legislation that limits the amount hospitals can charge under facility fees, including prohibiting fees charged for telehealth services where the patient isn’t on a hospital campus, but still experience facility fees because the health care professional is located in hospital facilities.
When asked if the GRHS will be charging telehealth patients with facilities fees, the question was unanswered due to the expert on the service not being available.
The hospital official said this new billing system is used by hospitals across the country, including many in the region. However, they are not trying to limit patient choice.
“Our goal is not to limit patient choice, but to maintain a system that ensures the long-term sustainability of healthcare in our community, while providing patients with the clarity they need about their care and associated costs.
“We understand that any changes in healthcare billing can cause concern, and we take those concerns seriously. Our priority is to maintain open communication with our patients and the public to ensure they understand the reasons behind the change. While we recognized that transitions like this may lead to questions or frustration, we are committed to addressing those concerns and helping our community navigate these changes.
State Sen. Jeff Reichman (R-Montrose) said he was made aware of the situation late Friday and has reached out to the Department of Health and Human Services, but said the action is a consequence of Obamacare and the Biden Administration, and needs more attention.
“Once again, we have an organization that’s under a financial crush as a result of the “Affordable Care Act” and this Biden/Harris economy,” he wrote in an email to Pen City Current.
“Rules from this administration that have caused burdens on our healthcare that is still recovering from Covid, funding, and staffing issues," Reichman wrote.
"At this time, we don’t have all the answers, so we definitely don’t have a solution. We are day one on this issue and it needs more attention. We would obviously like to have a solution to the issue that doesn’t involve people taking on more financial burden in this already troubled Biden/Harris economy.”
Efforts to reach Reps. Martin Graber and Matt Rinker were unsuccessful.
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