CAMP LESTER, Okinawa — Medical billing for Department of Defense civilians is getting more detailed.

A plan enacted Oct. 2 changed how military treatment facilities bill patients who seek medical care at hospitals and clinics.

The new plan, called the Uniformed Billing System, is designed to put military billing procedures on a par with industry standards. It does not affect Tricare beneficiaries.

“We’ve tried to mirror exactly what they do on the outside,” said Lt. Bruce Grimshaw, head of Okinawa’s U.S. Naval Hospital financial resources department. “It’s designed to help the insurance companies. They’re the ones requesting the itemized information.”

Fees used to be applied at a flat rate at military hospitals. The flat rate covered everything from examinations to pharmaceuticals, Grimshaw said. Bills now reflect costs for separate services provided during a visit. Rates now are separated into five categories: doctor’s time, procedures, medications, radiology and laboratory work. Prescriptions also carry a $6 dispensing fee.

The new Uniformed Billing System has caused complaints in Europe, where one Department of Defense Dependents Schools teacher opened her itemized bill and learned she was being charged $777 for a doctor’s visit and prescriptions for diabetes. Patients complained they weren’t informed of the pending changes before the bills arrived.

On Okinawa, however, hospital officials made significant efforts to get the word out. When the school year began, Grimshaw attended briefings to warn teachers of the changes. Hospital officials also have included information pamphlets with bills being mailed out.

“Patient complaints have actually dropped off,” Grimshaw said. “Education has really been the key.”

Public law requires military hospitals to “recover the reasonable cost of health care services provided,” according to a Department of Defense budget passed in 2000. Funds collected pay for medical equipment, supplies, furniture and continuing medical education for staff at the U.S. Naval Hospital on Okinawa.

“Insurance companies were accepting the bundled fees up until now,” Grimshaw said. “They didn’t have to.”

“It’s the same now as it would be in the U.S. with a civilian doctor,” said Nakisha Harris, the hospital’s business office superintendent. “I’ve worked for civilian doctors, and it’s the same way as we’re doing it now.”

The new billing practices are bringing changes to costs, too. Prior to Oct. 2, a visit to a family practice clinic cost a DOD civilian $156, and a DOD contractor $165. Now a straightforward visit, without X-rays, lab work or prescriptions, for a new patient is billed at $33.14 and for an established patient at $18.66.

“Someone coming in for a sore throat will probably be around a $30 or $60 visit and then go get the medications,” Grimshaw said. “There will be a corresponding cost with that.”

Hospital officials anticipate the new practice will reduce the overall amount of money they bill customers.

“We’ll probably collect a lot less money this year,” said Ray Teruya, the hospital’s claims examiner. “A same-day surgery that used to be $2,000 might now be as low as $400 or $500.”

The hospital here, and Kadena’s clinic, have taken the new billing procedure a step further. They bill insurance companies directly for the patients, so patients aren’t handed a bill as they walk out the door. Rather, bills are sent to insurance companies who pay their portion first. The remainder then is billed to the patient within two weeks of the visit.

The U.S. Naval Hospital at Yokosuka and its clinics at Sasebo and Iwakuni Marine Corps Air Station also bill insurance companies directly, except in cases in which expenses total less than $50. Clinics at Misawa and Yokota air bases and Camp Zama bill patients, who then must file claims with their insurance companies.

The 121 General Hospital in Seoul, on the other hand, said it bills insurance companies directly; the hospital also itemizes bills.

This isn’t necessarily done worldwide, a hospital spokesperson said, but 121 General does it as a "customer service."

The new billing practice makes choosing an insurance plan even more important, Grimshaw said.

“A lot of this deals with the insurance company,” he explained. “Companies may have 50 different plans — the difference between buying a Volkswagen and a Cadillac. … The most important thing is that our customers are very careful about looking at their plans and picking the right one for them.”

— Steve Liewer, Wayne Specht, Rick Chernitzer, Joe Giordono and Jeremy Kirk contributed to this report.

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