Orlando Health helps patients understand medical bills

Understanding how to decode and interpret medical bills is akin to learning a new language — or several at once.

From deductibles to out-of-pocket maximums to insurance and co-insurance coverages, the process can be confusing. That’s especially true when you or a loved one is still recovering and have more doctor or hospital visits ahead.

Orlando Health’s solution? Prepare patients and family members ahead of time, offering options and working with them on solutions.

“We want to help them,” says Keri Wilson, senior director of patient accounting at Orlando Health. “We want to work with them through this journey.”

Wilson’s team of 60 patient advocates and customer experience representatives walk through the often-complex billing practices of the American healthcare system, including insurance coverage and benefits, payment options, and patient financial help programs that Orlando Health has in place.

Often, it starts when the services are scheduled or Day 1 at arrival.

“When a patient seeks medical attention, their first concern is, ‘Am I going to be OK?’ Their second concern is, ‘Can I afford this?’ ” says Orlando Health Chief Revenue Officer Michele Napier.

The service team works to relieve the second concern. 

“We run an estimate of what services you are going to need and what your out-of-pocket estimate would be, and we immediately begin to work on solutions,” Napier says. 

Orlando Health offers several financial assistance options, from its Prompt Pay Discount if you prepay your projected final balance to zero-interest payment plans, including patient loan financing for larger balances. The healthcare system also has connections with local community organizations to assist patients.

The hospital system has contracted with almost all health plans and accepts Medicare and Medicaid. Typically, Orlando Health is reimbursed for inpatient services on a case rate. This means the health plan will pay the hospital for the patient’s stay at a flat rate not dependent on what services are performed during the stay. 

Some costs, such as anesthesiologists, are billed and paid separately from the hospital claim.     Patient out-of-pocket costs are based on their insurance company’s allowed amounts. For example, the hospital charges $2,000. The patient’s health plan, contracted with Orlando Health, allows $1,500 for the hospital stay. The patient has a 10 percent coinsurance and will owe $150 if the deductible is met. Many services, such as health screenings, do not have to meet the deductible.    

These days, patients have more insight into their healthcare costs than ever before. Each patient has a digital hub with Orlando Health through the Orlando Health MyChart patient portal. Through its secure login, patients can review documents, from prescription updates to test results to invoices and account balances.

The portal, which launched in early 2021, enables patients to private message doctors and hospital personnel with questions. It is also a fast and direct way to ask for help.

Both Napier and Wilson have family members who had cancer. Helping their loved ones through the billing process was the catalyst for the service program built at Orlando Health. 

“Whether a patient has one question or something more complex, we want to make things easier for them so they can focus on their health and recovery,” Wilson says.