John Muir Health

Initial Business Response /* (1000, 5, 2015/06/18) */
Mr. [redacted]'s concern revolves around the following three issues:
Rate Quote: John Muir Health agrees that transparency of charges and billing practices in health care need to be improved so that consumers can be better educated about...

what contributes to the cost of their care and make an informed decision about where to receive care based on their condition. In Mr. [redacted]'s case he came to John Muir on the day of his procedure and states he asked two representatives what the cost of the procedure would be after his insurance was applied. He has indicated that he requested a quote from the Receptionist and Registrar. Unfortunately, the employee's working at reception desks , registrars, radiology technicians, etc are not required to know the cost for each and every type procedure. Patient's are referred to a Financial Counselor. Our Registrars are trained to refer patients to financial counselors. Upon review, we are unable to confirm Mr. [redacted] inquired about a quote with the appropriate staff member. It is documented that he is eligible for benefits under his insurance plan and appropriate authorization was obtained. John Muir provides rate quotes to patients who inquire. Financial counselors obtain the correct CPT code, ICD9, and the patient's insurance. Financial counselors then facilitate their conversation with the patient regarding an estimate for their procedure. Please know quotes are only estimates. Ultimately, the patient is responsible for knowing their own benefits and coverage. This is written in the Financial Agreement Mr. [redacted] signed at the time of service.
High Cost: We understand that Mr. [redacted] feels the cost of his procedure is high, however while it is true medical costs in this day and age are frequently more than people are aware, John Muir Health, as a community, not-for-profit institution, strives to provide the best care at the lowest cost to the patients. Our charges are well within accepted limits for this area compared to other hospitals with the same overhead charges. With the implementation of healthcare reform and the added pressure of decreasing payment rates from Medicare, Medi-Cal and other payers both now and in the future John Muir Health is working diligently to reduce the cost of the care that we provide while maintaining the high quality of service for which we are known. As for his other hospital charges, the Center for Medicare and Medicaid Services(Medicare) mandates that all hospitals maintain a comprehensive price list known as a charge master. Medicare mandates that hospital use this charge master as the basis for billing every patient, regardless of the patient's insurance coverage or ability to pay for part or all of the services provided. Like any other hospital, we negotiate with the health plans to establish payments for services we render that are lower than what is on the charge master. According to the insurance plan Mr.[redacted] chose he is contractually responsible for the balance and if he has questions regarding his outstanding balance he may want to contact his insurance carrier for further explanation of his benefits.
Patient Assistance: As a community provider, John Muir offers financial assessment assistance to determine if a patient is eligible for relief from financial obligations. We will offer Mr. [redacted] a Financial Assistance Application. In addition, there are several interest-free monthly payment plan options available. As a one-time courtesy John Muir will cancel this account from collections to allow additional time to resolve the balance. Mr.[redacted] can contact John Muir directly to resolve the balance.
Sincerely,
[redacted]
Patient Concern Liaison
[redacted]
Patient Concern Liaison
John Muir Health
Single Business Office
XXX-XXX-XXXX
[redacted]@Johnmuirhealth.com