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Newspaper
Middletown Journal
Location
Middletown, Ohio, United States of America
Date
Jan 26, 1971
Page
7
Studies show initial days of some hospital stays are used for testing before treatment. Under PAT, Southwest Ohio Blue Cross Blue Shield pays for certain tests before admission whether done in the hospital outpatient department or in a doctor's office with X ray equipment.
The plan seeks to reduce patient bed days to lower hospital bills and ease bed shortages. It also aims to shorten time patients are away from family and employment.
Blue Cross and Blue Shield programs require three rules: the physician must decide on bed-patient care and arrange admission. tests must be relevant and medically valid at admission. tests aim for a shorter hospital stay.
Policy notes state Sx Payment will not cover tests used solely to decide admission necessity. Payments apply only to tests that would normally be performed during hospital care.
Hospitals in Southwest Ohio join a program allowing pre-admission X ray testing to be billed through Blue Cross. Members can have the doctor’s office X rays paid by Blue Shield when eligible. The aim is to cut costs by favoring outpatient services over inpatient care.
Southwest Ohio seniors 65 and older with Blue Cross Gap-Filler saw more hospital costs covered since Jan 1 as Medicare Part A deductible rose to 60 dollars. The program keeps 61st to 90th day costs at 15 dollars daily for those with Gap-Filler and raises lifetime reserve copays to 30 dollars per day, with Part B covering 80 percent of physician charges.
Area health care leaders discussed hospital costs on a two part Blue Cross program. They noted Ohio daily hospital costs around 78 to 80 dollars, with national per diem rising from 32 in 1960 to about 85 in 1970, and cited wage levels and cost control efforts as key factors.
A long Q and A explains why Blue Cross Blue Shield advertises despite high recognition. Advertising reaches mass audiences, reminders for member actions, new coverage education, and supports steady young-member enrollment to keep costs down. Board approval governs the program, and the cost is only about 1 percent per member per month.
As of January 1, 1971 under Medicare Part A the first $60 of hospital charges must be paid. Daily charges from day 61 to 90 rise to $15 a day, $2 more than 1970. Blue Cross Gap-Filler coverage can pay the $60 deductible and the $15 daily charges for days 61 through 90, totaling $510.
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