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Wednesday, Sep 4, 2019

Ballad Health physician practices reduce charges

17% reduction in charges to primarily benefit patients without insurance

As Ballad Health continues to make healthcare more affordable and accessible for individuals who have low income and do not have the benefit of health insurance coverage, the health system announced another step toward increasing accessibility by reducing charges. This announcement comes after Ballad Health has increased the threshold for patients who are eligible for charity care to 225% of the federal poverty level from the 200% threshold in place prior to the merger in February, 2018 – making healthcare more accessible for thousands of residents of the Appalachian Highlands region.

As Ballad Health has endeavored to move toward a standardized price structure across the Ballad Health Medical Associates, it announced a new, uniform pricing system for all professional fees for Ballad Health physicians and other caregivers. These changes result in a 17% overall average decrease in professional fees – as well as a 77% discount on these fees for patients without insurance.

The adjusted pricing took effect Sunday, Sept. 1, and it affects all charges from physicians, nurse practitioners and physician assistants employed by Ballad Health, including those with Ballad Health Medical Associates primary care and specialty practices and Ballad Health Urgent Care. It does not apply to “independent” or contracted physicians on hospital medical staffs, pharmacies or facility fees.

Virtually all Ballad Health providers will be affected by the change, but the exact amounts will vary.

“Making healthcare more accessible means making it more affordable,” said Dr. Mark Patterson, president of Ballad Health Medical Associates. “Our new professional fee structure will do both – giving many patients without insurance more opportunity to be healthier.”

This reduced pricing is not required by the Terms of Certification of the Certificate of Public Advantage in Tennessee or the Cooperative Agreement in Virginia. The price and discount adjustments follow a lengthy evaluation process of the pricing and charge structures from Ballad Health’s legacy systems. In addition to the decrease in prices, this evaluation resulted in the decision to increase the uninsured discount of 25% for legacy Mountain States clinic patients to match the discount received by legacy Wellmont clinic patients. That discount is now 77% across Ballad Health for all physician practices.

“As a unified system, Ballad Health is working to ensure our patients receive the same high-quality experience in all hospitals, medical practices and other care centers,” said Lynn Krutak, Ballad Health’s chief financial officer. “We’re dedicated to providing that experience in the most accessible and efficient manner possible, and this standardized pricing – which will result in decreased professional charges for many patients – is such a positive step forward.”

Krutak noted patients with insurance – including Medicare, Medicaid and commercial plans – should not anticipate a significant change to their out-of-pocket costs because patient responsibility is set individually by each insurer.

Ballad Health has taken several steps to reduce healthcare costs in the region, including:

  • Through its work to reduce readmissions and lower acuity admissions, in partnership with employer health plans, Ballad Health has reduced the cost of care. This was highlighted recently as the overall cost of care for employees of Washington County, Tennessee, was shown to decrease by 10%, resulting in a reduction in premiums for employees and lower costs for taxpayers.
  • In keeping with its agreement with Tennessee and Virginia through the Terms of Certification of the Certificate of Public Advantage and Cooperative Agreement to make healthcare more affordable for lower income patients, Ballad Health increased the threshold for low-income patients to qualify for free, or charity, care to 225% of the federal poverty level from 200% of the federal poverty level.
  • This new pricing for physician and professional services will significantly reduce the out-of-pocket costs for individuals who do not have the benefit of insurance coverage.

For more information about billing practices, please visit Ballad Health’s financial assistance policy or contact us with questions. 

Patients with questions about billing practices can also call (423) 431-1700 or (423) 408-7400.