Geisinger's MyEstimate® product provides patients with a self-serve portal for out-of-pocket estimates on nearly 300 services, generally the most frequently used ambulatory diagnostic services. Geisinger out-of-pocket estimates incorporate both employed physician and hospital expenses. Patients enter their insurance information, and estimates are tailored to their verified benefit coverage and location of the service requested (hospital-based vs. physician office or freestanding ambulatory setting). This product answers the consumer's question, "What will the encounter cost me?" The portal receives more than 850 "hits" every month. 

Because the prospective patient's insurance coverage is verified in advance, the estimate takes into consideration negotiated insurer rates rather than gross charges. The application provides additional information such as pre-authorization or primary care physician referral requirements.

The self-serve portal provides insurance verification and out-of-pocket options for Geisinger's largest contracted payers (by volume) and Medicare fee-for-service. This example of an estimate for an echocardiogram shows the financial information that a patient would receive through the self-serve portal.

For unlisted payers or services, such as an out-of-pocket estimate for heart valve replacement surgery, the online portal provides contact options for financial counselor assistance.

Patients may connect with a financial counselor by creating an on-line request, by calling, or by visiting a local service location. Uninsured individuals are connected with a financial counselor to pursue funding options such as state program enrollment, interest-free payment plans, or uncompensated care discounts. Financial counselors conduct about 1,000 pricing interviews per month.

Geisinger financial counselors are CMS Certified Application Counselors (CACs) tasked with assisting consumers with creating healthcare marketplace accounts and evaluating options to purchase health insurance coverage. As of Jan. 1, 2014 CACs provide presumptive eligibility in Pennsylvania’s Medical Assistance program.

Geisinger's Financial Counselors, Certified Application Counselors, and MyEstimate® comprise its Patient Advocacy program.

Future enhancements planned for 2014 to the portal will provide open access to average Medicare reimbursement rates for selected services, i.e., inpatient and ambulatory surgical, ambulatory diagnostic services, etc.

Patients and/or prospective consumers will be able to calculate their own out-of-pocket estimates based upon their unique service and insurance coverage. When there is no patient responsibility established for the service in question, possibly for Medicare and Medicaid, that will be noted. There will be links to MyEstimate® on every navigation screen for patients who wish to have more exact estimates.

Geisinger provides a link to the quality report(s) for quality measures reported by The Joint Commission, the Pennsylvania Health Care Cost Containment Council, Pennsylvania Healthcare Alliance, and Geisinger Health Plan HEDIS Quality reports. For example, the patient who received the out-of-pocket estimate for heart valve replacement surgery could access quality information from the Pennsylvania Health Care Cost Containment Council through the Geisinger quality portal. This page also provides a link to Hospital Compare reporting which takes the consumer to the site. Patients who perform this quality report search would now have both financial and comparative quality information.