Monday, Jan 6, 2020

Ballad Health takes steps to reduce costs for low-income patients and patients with high insurance company deductibles

Health system increases discount for uninsured and expands access to free and discounted care

Ballad Health is today announcing several additional steps to reduce out-of-pocket costs for patients who are burdened by the high cost of healthcare, in addition to measures previously taken to address the issue.

In September 2019, Ballad Health announced an average 17% price reduction for all physician practices and urgent cares, and it increased the discount for people who are uninsured to 77%. These steps and others have been demonstrated to have reduced the overall cost of healthcare. Recently, the Mayor of Washington County, Tennessee, credited steps Ballad Health has taken with an up to 10% reduction in insurance premiums for county employees and a reduction in overall healthcare costs.

In addition to making free and discounted care available to more qualifying uninsured families and individuals, these new steps also include assisting patients with insurance who have incomes up to 450% of the federal poverty level and who have suffered with higher deductibles and co-pays imposed on them by insurance companies.

Even as insurers have reported significantly higher earnings, many insurers are shifting more costs onto patients. According to a Kaiser Family Foundation survey, four in 10 U.S. workers had difficulty paying a medical bill or insurance premium in the previous 12 months, and nearly half of those workers in a plan with at least a $3,000 individual deductible or a $5,000 family deductible reported problems affording healthcare.

“The steps being announced by Ballad Health today are intended to be helpful to the people in our region, but they are in no way a long-term solution to the affordability crisis in healthcare,” said Ballad Health Chairman and CEO Alan Levine. “The ongoing shifting of costs by insurers to patients is unfair, and it is certainly not reasonable to expect patients and rural and non-urban hospitals to shoulder the burden of the cost. There has to be a better long-term solution.”

Additional steps being taken by Ballad Health to provide relief to patients experiencing unaffordable costs include:

  • Increasing the discount off charges for uninsured patients at all Ballad Health physician practices, urgent cares, diagnostics and hospitals to 85%. These discounts are effective immediately and are above what was announced in September 2019.
  • Beginning April 1, Ballad Health will be implementing “presumptive eligibility” for patients who could be eligible for free care or discounts under Ballad Health’s expanded charity policy. Using publicly available data and newly acquired analytic tools, Ballad Health will be capable of determining if a patient is likely to be eligible for free care or for discounts. This will reduce barriers to receiving charity care (such as producing hard-to-find paperwork), therefore reducing the number of patient bills labeled as bad debt or referred for collections. In many cases, the discount will be applied to patients who aren’t even aware they are eligible.
  • Ballad Health will continue to make patient financial navigators available to help patients evaluate their options and assist with applications for programs such as Medicaid or other financial assistance.

Prior to the merger creating Ballad Health, patients with incomes up to 200% of the federal poverty level could qualify for charity care. After the merger was closed, the charity threshold was raised to 225% of poverty level, providing thousands more qualifying individuals access to free care. For those with incomes just above 225% of poverty level and up to 450%, a generous sliding scale discount is applied. One of the most generous charity programs in the country, these partial and total discounts based on income apply not only to individuals without insurance, but also to the out-of-pocket expenses for those with insurance.

For example, a qualifying family of four with a total family income of $57,938 or below could now be eligible to receive care at no cost to them, even if they are insured and have deductibles or copays. Ballad Health will absorb these out-of-pocket costs.

“Our patients have told us they worry about unexpected or unaffordable healthcare bills, and we’re listening to them to address their concerns,” said Eric Deaton, Ballad Health’s chief operating officer. “The steps we are taking are intended to be helpful to people who have been hard-hit by insurance company policies designed to shift unconscionable levels of cost onto patients. While the hospitals are absorbing this cost, the cost is nevertheless still there.”

“The struggle of individuals to meet payments with high-deductible health plans is a significant challenge throughout the nation,” said Lynn Krutak, Ballad Health’s chief financial officer. “There’s a misconception that just because someone has health insurance, they can afford their bills, but that’s not always the case.”

As part of this process, Ballad Health has updated its chargemasters to align them between its legacy health systems. The chargemaster for the system is posted at and consists of tens of thousands of codes and charges. Every hospital nationwide is required by law to post its chargemaster publicly.

Changes to the Ballad Health chargemaster have been reviewed by the state COPA monitor and have been determined to be in compliance with the provisions of the COPA intended to limit the prices Ballad Health may charge.

In the recent meeting of the Southwest Virginia Health Authority, the independent monitor employed by the Authority reported that hospital chargemasters are “not terribly meaningful,” because the chargemaster is an accounting tool intended to capture all of the costs experienced in the health system; yet, almost no patient, employer or insurance company pays what is in the chargemaster. For the 70% of Ballad Health patients who are either uninsured or covered by government programs, the reimbursement to the hospitals is generally below the actual cost of providing the care. Ballad Health joins many rural health systems with private insurance coverage representing only about 25% of all patient volume.

“The changes announced by Ballad Health today to expand discounts and access to charity care are not required by the COPA, nor have they been imposed by either state,” Levine said. “These changes are a result of Ballad Health’s board of directors and leadership listening to the concerns of our patients, recognizing the hardship that has been imposed by insurers shifting higher costs to patients through unaffordable premiums and deductibles, and they are intended to be responsive to those concerns.

“When people buy insurance, they deserve peace of mind knowing they can access the coverage when they need it. It is terribly unfair to families who find out, at their most vulnerable time, that they cannot access the coverage they thought they had,” Levine continued. “Hospital charity programs cannot be expected to solve this problem alone. Working with health care providers, insurance companies and federal policymakers have to come up with a more sustainable solution. A rural health system with only 25% commercial payer mix cannot survive if the expectation is that insurance, pharmaceutical and other medical companies can shift cost to patients, and then hospitals are forced to pay for these costs by writing off necessary care that patients can’t be expected to afford.”

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