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Published on January 11, 2021

Avera Offers Online Tool to Estimate Health Care Prices

Avera has launched a consumer-centric price estimator that provides out-of-pocket cost estimates for shoppable health care services.

The tool launched at the end of October in the “Patients and Visitors” section of Avera.org.

“In a recent survey, we found that more than 40% of consumers want access to a pricing tool that gives them information on their out-of-pocket costs for health care services,” said Kendra Calhoun, Avera Senior Vice President of Strategic Marketing, Communications and Public Relations. “While Avera has historically provided cost estimates when requested, this tool is self-serve and is only one example of Avera’s focus on our digital front door and engagement with our consumer-patients.”

Beginning in January 2021, the Centers for Medicare and Medicaid Services (CMS) are requiring hospitals to provide a price estimator tool for many shoppable services performed by hospitals.

“The new CMS requirement for transparency helped us move faster to make this tool available on our website,” said Calhoun. “Health care is in the midst of a shift toward a more consumer-centric model. Health care consumers are expecting their experiences with health care to mirror those in the retail space, especially as patients take on more financial responsibility. There is very little out there that you can’t Google and get a cost estimate.”

Avera’s cost estimator tool allows consumers to select their service and Avera hospital, and input their existing insurance plan information. The tool then uses artificial intelligence to gather information on the consumer’s specific co-pays and deductibles and scans the health care provider fee agreements with the respective insurer to determine the personalized best estimate of out-of-pocket costs for the specific service the consumer is seeking. Uninsured consumers can also get a cost estimate that includes cash pay discounts.

The estimate is only for out-of-pocket cost for services at the selected Avera hospital. Additional services that may not be part of the estimate include, but are not limited to, professional fees, anesthesia services and radiology technician charges. Patients may receive additional bills for services ordered.

“We are very much focused on the future of health care,” said Calhoun. “We think the future is consumer-centric and digitally-enabled. And, we think our work in this area will enhance patient experience, build lifetime relationships with our patients by helping them more easily navigate health care and meet them where they are in their care journeys.”

The CMS rule was finalized in 2019 and requires a comprehensive “standard charges” file be posted online, and offer information on things such as gross charges, discounted cash prices and payer-specific negotiated charges. Additional information will be included in the tool before the beginning of 2021.

The price transparency rule is for hospitals; clinics and long-term-care facilities are not included in the tool.

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