According to a survey by the Centers for Disease Control (CDC), in 2017, more than 28 million Americans didn’t have health insurance. In 2018 and beyond, this number is expected to skyrocket, since there’s no longer a healthcare mandate requiring insurance coverage. 

Many people choose not to carry health insurance because they can’t afford the high deductibles that most plans come with. For people who can’t afford high deductibles, the cost of a medical procedure can be a huge financial burden. This causes many people to delay critical procedures, resulting in even more health problems (and increasing long-term costs exponentially).

That’s why we created our Patient Assist program — to leverage the experience of our team to negotiate and bundle provider services, resulting in discounted all-inclusive rates. Think of it as insurance for the uninsured.

Below, you’ll learn how New Choice Health’s Patient Assist program works, from start to finish.

Who qualifies for Patient Assist?

The Patient Assist program is available to patients who are:

• Uninsured
• Under-insured
• On high-deductible insurance plans (who want to seek care outside of their health plan)**

Patient Assist is ideal for healthy patients in need of routine, low-risk procedures. Not sure if you qualify? Applying is quick and free.

What procedures can I use Patient Assist for?

While more procedures will be added, we currently focus on four popular medical procedures. These include:

• Colonoscopy
• Endoscopy
• Gallbladder surgery
• Hernia repair surgery
• Spine surgery
• Orthopedic surgery
• Gynecological surgery

How does Patient Assist work?

Patient Assist is not intended to replace having health insurance. Instead, it’s a stand-alone program that helps patients afford the care they need. Once you apply to the Patient Assist program, the entire process can happen in as little as a week, since most of our providers offer same day and next day procedures. We cannot accommodate emergency needs. Patients with an emergency should call 911.

Here’s a breakdown of each step you’ll go through with Patient Assist — from application to recovery. Keep in mind, you’ll have a Patient Assist Care Coordinator helping you every step of the way.

1. Apply for the Patient Assist program

When you’re ready to apply for Patient Assist, all you have to do is fill out a short application. This application asks for basic information like your full name, date of birth, email address, and phone number. You’ll also need to select which type of procedure you need.

You can find the Patient Assist application here.

2. Schedule an initial consultation with a Care Coordinator

A Care Coordinator will receive your application and contact you to set up a time to talk on the phone. The first thing your Care Coordinator will do is confirm that you are eligible to participate in the Patient Assist program.

Then, your Care Coordinator will:

• Review your medical needs
• Go over the price of the procedure
• Find out if you need special financing (more on that below)
• Match you with a high-quality healthcare provider who has experience doing the procedure you need
• Answer any questions you have about the program or your procedure

3. Complete your medical forms

Once your Care Coordinator has determined your needs and matched you with a provider, you’ll begin completing medical forms. These are the forms that your doctor will need to schedule your procedure; they allow your doctor to screen your health history prior to scheduling an appointment. This helps them make sure they’re a good fit to handle your procedure, as well as alerts them of any possible diagnostic tests that may be needed.

Your Care Coordinator can help you complete the forms over the phone, or they can email you a copy to complete online.

4. Apply for financing, if needed

Even with Patient Assist, some patients worry about whether or not they’ll be able to afford their medical procedure.

We’ve partnered with CareCredit to bring you an additional payment option. With short- and long-term financing options at either no or low interest, this can be a great way to supplement the cost of your medical procedure. To qualify for CareCredit, you do have to apply separately. Before you do, it’s best to talk to a Patient Assist Care Coordinator to find out how much your procedure will actually cost.

5. Schedule your procedure

Once the forms are completed, you’ll be put in touch with the provider you were matched with. But there’s nothing you have to do at this point—just sit back and wait for them to reach out to you to schedule your procedure. This typically happens within two business days. Some providers even allow your Care Coordinator to schedule your appointment for you. They’ll let you know if this is an option.

6.   Pay your Patient Assist bill

Once your appointment is scheduled, Patient Assist will send you a bill. This bill will be due before your scheduled appointment. Don’t worry—you won’t receive any surprise bills from Patient Assist. You’ll know exactly what you owe before you get the bill. If you have any questions about your bill, you can reach out to your Care Coordinator for assistance.

After you’ve made your payment, your doctor’s office receives authorization from Patient Assist to continue with the scheduled consultation/procedure.

7. Have your procedure

Once your appointment is scheduled with your provider and your bill is paid through Patient Assist, you’ll be ready to have your procedure.

Each person, and each procedure is different, so your doctor will provide you with any pre- and post-procedure instructions you need to follow. Again, if you’re unsure of what to do, contact your Care Coordinator. They’re here to help!

8. Your Care Coordinator will follow up with you

After your procedure is completed, your Care Coordinator will check in with you. They’ll ask about your experience and make sure you were given excellent care. At this time, you can ask any additional questions you have.  

As you can tell, using Patient Assist is easy! Your Care Coordinator is there for you the entire time—via phone, email, or text message. It’s their goal to make the process smooth and clear, while addressing any concerns or questions along the way.  

Ready to find out if you qualify, so you can save money and get the care you need?

Apply for Patient Assist now!

(** – provider options are limited for patients in this category.)

If a medical procedure costs more at Facility A than it does at Facility B, that means the quality of healthcare is better, right? Not exactly. It’s a good question, though. Many people are unclear about the relationship between the cost and quality of healthcare in the United States — experts included.

One of the reasons this topic seems complicated is because the U.S. spends more on healthcare than the rest of the world but Americans are not any healthier, nor do they live longer, than citizens in other industrialized nations. If cost and quality of healthcare went hand in hand, Americans would be a lot healthier than they are.

So, how are cost and quality related in healthcare? Put simply, they’re not. The cost of healthcare is driven largely by economic factors such as inflation, recession, wars, and government policies. On the other hand, there are quality driven factors in healthcare such as provider competency (skills and training), satisfaction (work-life balance), and the availability of resources. None of these quality factors have any impact on the cost of medical procedures.

Below, you’ll find out why some medical procedure prices are so high, whether a higher price tag means better care, and how to make sure you’re getting a fair price for healthcare.

What determines the cost of a medical procedure?

There’s no universal formula for how much a medical procedure costs. Every single type of procedure, as well as the circumstances of the person receiving it, is different. However, there are certain factors that can impact the cost of healthcare. These include:

Whether the doctor or facility you go to is in- or out-of-network

The term “in-network” refers to a doctor or healthcare facility that has negotiated a discounted rate with your insurance company. When you get in-network care, you often pay a lot less than you would for out-of-network care. Your insurance company may still cover some of the cost of out-of-network care but you’ll be stuck with the majority of the bill.

The cost of a medical procedure can fluctuate greatly just based on whether the doctor or hospital you go to is in your insurance network or not. If you don’t have health insurance, you can expect to pay for the cost of care completely out-of-pocket, obviously making your cost much higher.

The type of doctor you see

If you see a specialist, your medical procedure will likely cost more than if you were treated by your regular doctor. The type of doctor you see — and whether they’re contracted with your insurance company — plays a big role in the total cost of care.

Which type of facility you go to

Many medical procedures that are done at a hospital can also be done (for a much lower price) at an ambulatory surgery center or outpatient clinic. The reason these alternative facilities tend to cost less is that they don’t require as much money to operate as large hospitals do. Don’t worry, though — surgery centers are just as well equipped as a hospital.

The state in which you receive care

In some states, healthcare just costs more. Medical procedures in states like New York and California tend to come with a higher price tag. However, this doesn’t necessarily have to do with socioeconomic factors. According to a RAND Corporation study, “quality is similar in cities with higher and lower rates of those without insurance, poverty, penetration of managed care, and supply of hospital beds and doctors.” This is where traveling for a medical procedure can help save your wallet.

Your insurance co-pay, deductible, and co-insurance

Every health plan is different when it comes to the co-pay, deductible, and co-insurance amounts. If you’re not familiar, here’s a quick overview of what these costs are:

• • A co-pay is the fixed amount you pay for a healthcare service. The amount can vary depending on whether you’re seeing a primary care provider, a specialist, or having a prescription filled. Co-pays can be charged both before and after you’ve met your deductible.
  • A deductible is an amount you must pay for healthcare before your insurance kicks in and starts paying.
  • Co-insurance is the amount you pay for healthcare after you’ve met your deductible. Your insurance has already started to pay at this point, so you’re only responsible for the set co-insurance percentage determined by your health plan (as well as any co-pays).

Of course, these costs affect the price you pay out-of-pocket or with an HSA, not necessarily how much a procedure actually costs. Still, it’s a good idea to have a basic understanding of the costs you’ll be responsible for.

Is the quality of healthcare affected by the cost?

The reality is, no, a more expensive medical bill doesn’t mean you got better care. The cost and quality of healthcare are, in general, unrelated.

There are a lot of reasons healthcare costs become inflated — over-reliance on emergency room care, chronic disease, and government policies, to name just a few. None of these correlate to higher quality care, better patient outcomes, or more patient satisfaction. Instead, they just point to a healthcare system with a lot of fundamental problems, one of those being the cost of care.

That brings us to an important question: if you can’t look to the price of a medical procedure to determine whether you’ll receive quality care, what can you do?

How to accurately measure the quality of care

There are several metrics that can be used to determine the quality of healthcare. Healthcare policy makers encourage doctors to focus on value-based care (in other words, making sure they spend enough time with each patient, treat their medical concern accurately and effectively, and provide a good overall experience). Healthcare consumers can use similar metrics to determine whether a doctor or facility will provide them with high-quality care.

Which metrics can be used to determine the quality of care?

• Qualifications of the doctor/surgeon — If you compare costs without comparing qualifications, you’re not alone. Many people don’t even think to look into the qualifications of their doctor. To make sure you’re receiving high-quality care, check to find out if your doctor or surgeon is board certified (you can do that here).
• Accreditation of the healthcare facility — Whether you get a medical procedure at a hospital or a standalone surgery center, it’s smart to make sure they’re accredited. Hospitals should be accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). If you’re being treated at an ambulatory or outpatient surgery center, you can check to see if the center has been accredited by the Joint Commission or the Accreditation Association for Ambulatory Health Care. These accreditations are not necessary for a healthcare facility to operate but when they’ve voluntarily sought accreditation, it’s a good sign that they’re committed to providing high-quality care.
• Number of procedures performed — As a rule of thumb, the more a doctor performs a medical procedure, the better they are at doing so. In fact, U.S. News added surgical and procedure volumes to doctor profiles on their Doctor Finder site.
• Readmission and mortality rates — Readmission to the hospital (or another type of healthcare facility) can happen for a number of reasons. Regardless of if a surgeon or hospital is specifically at fault, high readmission rates are not a good sign. Likewise, death (mortality) rates are a very bad sign. Of course, there are some cases in which a doctor or hospital is not at fault and nothing could be done, such as due to underlying health conditions. However, it’s a good idea to ask for them to share both readmission and mortality rates for any medical procedure you’re considering — before you have it done.
• Patient satisfaction — Last but certainly not least, patient satisfaction is one of the most helpful measures of quality in healthcare. The amount of time you spend being actively treated for a medical condition is relatively small in comparison to how much time you’ll spend interacting with staff, planning for your procedure, and engaging in your recovery. Hearing from other patients about their experience at every step can clue you into the level of quality you can expect.

What does the lack of correlation between cost and quality of healthcare mean for you?

When you’re buying cereal, a higher price tag may mean better ingredients. When you’re paying for a medical procedure, a higher price tag doesn’t necessarily mean anything at all. There are many ways to determine the quality of care but cost just isn’t one of them.

Still, the cost of healthcare is a concern for many people. Whether you have a high deductible health plan or no insurance at all, it’s understandable to want more transparency around how much you’ll pay for care.

The lack of connection between cost and quality of healthcare means that you can rest easy knowing you don’t have to wipe out your savings account to pay for a medical procedure. Instead of focusing on cost, you can compare surgeons and facilities based on the quality measures listed above.

Better yet, you can use New Choice Health to compare health facilities. We’ve done all the work for you, so you can save time and money while getting top quality of healthcare possible.

There are a lot of factors that affect how much you pay for a medical procedure. These include things like insurance network, the type of doctor you see, the state you live in, and the type of facility you go to. To learn more about what determines how much a medical procedure costs, check out our recent post on the topic. In this article, you’ll learn how inpatient vs. outpatient care can affect the cost of your medical procedure and what this means for you, as a patient. Let’s take a look.

What is the difference between inpatient vs. outpatient healthcare facilities?

Healthcare facilities exist on a spectrum and can range from big-name hospitals with thousands of staff members to small, local clinics where the front desk staff know your name. Each type of facility comes with its own set of benefits and disadvantages.

There are two main types of facilities you can have medical procedures done at: inpatient and outpatient centers. The main difference between the two is how long you have to stay in the facility after your medical procedure.

What is inpatient care, and which facilities provide it?

To qualify as an inpatient, you have to be admitted to the hospital by your doctor and stay for a minimum of one night after your medical procedure. You’re considered an inpatient from the day you are admitted to the day you’re discharged.

Usually, inpatient care is given at a hospital. The hospital can either be a non-profit, for-profit, or state or local government facility — all of which have different price points (more on that below).

What is outpatient care, and which facilities provide it?

If you are cleared to leave the facility on the same day you have your procedure, you’re considered an outpatient. However, some people who get outpatient services can stay overnight, especially if they need to be observed for complications.

Outpatient care facilities include ambulatory surgery centers, hospital outpatient centers, and perhaps surprisingly, hospitals. Some outpatient services are done at a primary physician’s office, too.

It’s important to note that a facility being inpatient vs. outpatient doesn’t affect the quality of care. As long as it’s an accredited facility with board-certified, experienced doctors, the quality of care you receive should be the same.

Can you choose between inpatient and outpatient care?

It depends on your overall health, as well as the medical procedure you need. More and more procedures can be done at outpatient facilities but you’ll need to check with your doctor to see if outpatient care is an option for you.

What is the cost difference between inpatient and outpatient care?

A survey done by the Centers for Disease Control (CDC), found that, “in 2014, outpatient surgeries constituted 65.9% of total surgeries.” That number is steadily rising as more and more outpatient surgery centers open. But is there a significant cost difference for patients, depending on whether they have a procedure as an inpatient or outpatient?

Good question. The reality is that there are many factors that affect cost, even within the context of which facility you go to.

Overall, it makes sense that inpatient care would be more expensive because there are more costs associated with an overnight stay in the hospital. But it’s not exactly that cut and dry.

Let’s take a look at which factors affect the cost between facilities:

• Which type of facility you go to —  Ambulatory surgery centers and physicians offices require less overhead than hospitals do. This can translate into lower medical procedure costs for you. Hospitals tend to cost more, depending on where they’re located.
• Whether you stay overnight in a hospital and how that stay is classified — You generally won’t stay overnight at an ambulatory surgery center or a doctor’s office. But since you can get both types of care at a hospital, cost boils down to whether your doctor admits you as an inpatient vs. outpatient, and which one your hospital bills you for.
• Whether they are in-network or not — Of course, whether a facility is in- or out-of-network can really impact the cost. In-network facilities will almost always cost less than those that haven’t negotiated a rate with your insurance company.
  
• The billing rate for your insurance company — Some insurance plans cover inpatient and outpatient care at the same rate. Others charge different rates for each. Depending on your copay, deductible, and coinsurance, this could add up to a lot of money saved — or spent.

Inpatient vs. outpatient as a Medicare patient

The type of insurance you have can make a big difference in the cost of care. In fact, an article published at StatNews highlights that people with Medicare could pay higher rates for outpatient care. “People entitled to benefits under Medicare who had heart stents inserted as outpatients faced hospital bills that were $645 higher on average than those who had the same kind of procedure as inpatients, the Health and Human Services inspector general has found.

The billing discrepancies stem partly from Medicare’s complicated design. Beneficiaries pay a deductible for inpatient care, currently $1,288 per stay. Outpatient care is billed differently, with beneficiaries responsible for 20 percent of the cost of services, after a small deductible.” Medicare does outline its definition of each but there’s still not a lot of confidence about what a patient will have to pay.

There’s a reason people are confused about the difference between inpatient and outpatient care. Thankfully, there are plenty of ways to navigate the system and ensure you’re getting a fair price:

• Contact your insurance company and find out what the billed rate is for inpatient and outpatient care
• Always check to see if a facility is in-network before receiving care
• Look for outpatient facilities when possible
• If you get a high medical bill, you can ask the hospital to check which codes they used to classify your stay
• If you’re on Medicare, be sure to address any billing discrepancies you find
• If you have a high deductible health plan or are going to pay for your medical procedure out-of-pocket, you can save 40-80% with Patient Assist.

It’s time to stop paying more than you should for medical procedures

In-network, out-of-network. Inpatient, outpatient. The ins and outs of healthcare costs are confusing. New Choice Health advocates for you, letting you compare cost and facilities, save money, and get high-quality care. Use New Choice Health now!

Worried about how you’re going to afford care? Learn more about New Choice Health’s Patient Assist program now!

Each year, the number of visits to outpatient surgery centers goes up. Why? Convenience and cost are the two main reasons patients seek care at outpatient surgery centers, also called ambulatory surgery centers (ASC), instead of hospitals.

Now, more than two-thirds of operations performed in the United States occur in ASCs, according to Kaiser Health News—that’s significant. But even as outpatient procedures become more commonplace, there’s one looming question: are ambulatory surgery centers safe?

The answer is a resounding yes, at least most of the time and for most people. As with anything regarding healthcare, there’s no one-size-fits-all solution. Still, ASCs are a great alternative for people looking to save money on medical procedures, without compromising on quality.

Learn more about how the quality and cost of healthcare are unrelated.

Keep reading to learn how ambulatory surgery centers are regulated, when it’s best to go to a hospital, and how you can ensure you have a good experience at an ASC.

How are outpatient surgery centers regulated?

Surgeons at ASCs routinely and safely perform many types of outpatient procedures. One of the reasons they are so safe is that they are held to the same standards as hospital-based facilities. The Ambulatory Surgery Center Association (ASCA) exists to make sure ASCs deliver “high-quality, cost-effective care” to their patients.

The ASCA notes that, just like hospital outpatient centers, ASCs have to comply with a lot of laws, rules, and regulations. At a minimum, all ambulatory surgery centers have to have a state license. For most, the regulation doesn’t stop there.

Outpatient surgery centers can get three types of accreditation

If an outpatient surgical center wants to be a part of a health insurance network (which many do, for financial reasons), they need to have more than a state license. There are three major accreditation organizations that allow a provider to become part of an insurance network. Each of these organizations requires that rigorous guidelines be met before an ASC can become certified. They have to renew these certifications regularly, too.

1. Accreditation Association for Ambulatory Health Care
2. Joint Commission on Accreditation of Healthcare Organizations
3. American Association for Accreditation of Ambulatory Surgery Facilities

Even if the center chooses not to be in-network, the majority of them will seek out accreditation. If a center is not accredited, it’s probably better to keep looking.

Ambulatory surgery centers can be Medicare-certified

For patients with Medicare or Medicaid, good news: ASCs can become Medicare-certified. This means they’ve undergone even more testing to meet the eligibility requirements for program participation. Even if you don’t have Medicare, look for a center who is certified by them.

Outpatient surgery centers are held to a high safety standard  

In addition to being accredited by the healthcare rating agencies (Medicare included), ASCs have to:

• Maintain a strict sanitary environment
• Establish and maintain programs and procedures for preventing infections
• Conduct comprehensive assessments of the quality of care they provide

Patient safety is kept front-of-mind for hospitals and ambulatory surgery centers alike. There’s really no difference when it comes to the emphasis that is placed on high-quality, safe care.

How well are ASCs equipped to handle emergencies?

In general, different types of healthcare facilities can handle different levels of emergency.  ASCs can provide minor emergency care. That is, if you have a minor complication during your medical procedure, your surgeon can probably handle it then and there.

However, if you have a major complication, you’ll likely be transferred to a nearby hospital. Overall rates of transfer to hospitals from ASCs are very low. Even the state with the highest transfer rate — Alaska — has only a 1.420 rating. This means that out of 1,000 procedures, less than 2 required a hospital transfer. Those are pretty good odds. You can see which states have the lowest ASC to hospital transfer rates and which have the highest.

Before scheduling a procedure at an ASC, find out if your doctor has admission rights to a nearby hospital, just in case there is an emergency.

When is it better to go to a hospital?

Despite ASCs being incredibly safe for most patients, they aren’t for everyone. If you have serious underlying health issues (even if they are unrelated to the procedure you’re getting), you may want to consider going to a hospital instead.

Hospitals are generally better equipped to handle life-threatening emergencies. Even if the medical procedure you’re getting is low-risk, certain health issues can make complications more likely.

7 risk factors that can negatively impact the safety of a procedure at an ASC:

• Congestive heart failure
• Chronic lung disease
• A bleeding disorder such as hemophilia
• Serious arrhythmia
• Obesity
• Uncontrolled diabetes
• A heart attack within the past four to six months

Ultimately, whether you go to an ASC or hospital will be something you and your doctor decide together. If they think you should have your procedure at a hospital, they’re probably right. Otherwise, going to an ASC is a safe and more affordable alternative.

Questions to ask your outpatient surgery center

As you can see, going to an ambulatory surgery center is safe, as long as you don’t have major underlying health problems. Still, it’s always a good idea to get as much information as possible about a center. This will help you to feel confident in your decision.

Here are 6 questions to ask your ASC, before you schedule your procedure:

1. Is your center accredited? Be sure they are certified by at least one of the following: Accreditation Association for Ambulatory Health Care, Joint Commission on Accreditation of Healthcare Organizations, or American Association for Accreditation of Ambulatory Surgery Facilities.

2. What is the hospital transfer rate? Hospital transfers can happen for a number of reasons but, ideally, the ASC you choose will have very low transfer rates.

3.  How many patients have to be hospitalized due to infection after this procedure? Their answer should be “zero” or as close to it as possible. High infection rates reflect poorly on the ASC facility and staff.

4. How much experience does the surgeon have performing my medical procedure? Studies have shown, time and again, that surgeons with more experience performing a specific type of procedure have higher success rates. That also means they have lower readmission, hospitalization, and complication rates. Look for a doctor who has performed your procedure at least 50 times within one year.

5. Who is the anesthesiologist? You may need to go under general anesthesia for your procedure. If so, ask to make sure the anesthesiologist you’ll see is board-certified. Bonus points if they’re in your insurance network, meaning you’ll pay less to see them.

6. What’s the emergency plan? Consumer Reports recommends that you “ask whether emergency medications and resuscitative equipment are on-site, if there is a procedure for using them, and whether your doctor is certified in advanced resuscitation techniques. The facility should also have a plan for transferring you to a hospital, if necessary.”

7. Are you a part-owner? This is one question you should ask your doctor if he or she recommends you have a medical procedure done at an outpatient center. While outpatient surgery centers are safe most of the time and for most people, it’s important to keep an eye out for doctors who have a vested financial interest in you going to a facility that gives them a pay out. That’s not to say you shouldn’t get surgery at an outpatient center if your doctor is part-owner. But you should get a second opinion before following their lead.

You don’t have to go it alone

Don’t let the cost of a medical procedure stop you from getting the care you need. At New Choice Health, we’ve leveraged our knowledge of the industry to help you get a fair price for every procedure. Use New Choice Health to compare costs now!