Hospitals charge unequal amounts for sexual assault exams across the state and the uneven costs have strained the budget of the Vermont Center for Crime Victims.
The Senate Judiciary Committee is vetting a broad bill, H.735, which is intended to help the Vermont Center for Crime Victims Services plug an anticipated $1.3 million budget gap through a variety of measures.
One option under consideration would rein in the amount the victims compensation fund pays to hospitals for sexual assault exams.
A 2013 study of the center’s finances found the cost of sexual assault exams varied widely among hospitals, and insurance companies were rarely charged for the expense.
Senators on Tuesday said they want to make sure hospitals aren’t overcharging the fund, which doesn’t have a negotiated contract with hospitals, unlike Medicaid or private insurance companies.
“Are they billing, like, what’s the top dollar because they know they can get it or are they billing what Medicaid would pay? Shouldn’t they be billing what Medicaid would pay?” asked Sen. Dick Sears, D-Bennington, chairman of the committee.
Because sexual assault victims often want to remain anonymous, many don’t want to report the exam to their insurance companies, according to experts who testified before the committee.
Of the 170 exams paid for by the center in 2013, 47 were billed to private insurance.
Jill Olson, a lobbyist for the state’s hospitals, told the committee hospitals are struggling to assess how many sexual assault examinations are performed and what was charged.
One problem is that there is not a single insurance billing code for sexual assault exams. In addition, each exam is unique and requires different services.
“We have tried to get a handle on the data about how many exams are happening in which hospital and how much is being charged and that has proved to be not easy to do because there’s not a dedicated code in the traditional billing systems,” Olson said.
Olson, vice president of policy and legislative affairs for the Vermont Association of Hospitals and Health Systems, agreed to work with the Vermont Network Against Domestic and Sexual Violence to propose a way to make prices consistent statewide.
The state has a network of Sexual Assault Nurse Examiners (known as SANE nurses) who provide sexual assault exams and other care to victims of sexual assault.
Sarah Kenney of the Vermont Network Against Domestic and Sexual Violence, said it is important not to jeopardize that program, which hospitals support, because it is extremely beneficial to victims.
An exam can take from four to six hours, involve a nurse and doctor, internal and external exams and lab tests, Kenney said. Depending on the risk of HIV or exposure to sexually transmitted infections, patients may also be given preventive medications, which can be expensive, she said.
State law says the victims compensation fund may pay for medical exams (and mental health counseling) administered to victims of alleged sexual assault.
The fund can reimburse the health care providers 70 percent of the charge for the exam and services, the law says. The health care provider cannot bill any balance to the victim, the law says.
The center’s victims compensation fund paid $100,000 to Fletcher Allen Health Care in 2013 for 59 victims, according to the study, an average of about $1,700 a person.
It is extremely difficult for hospitals to predict the cost of an average sexual assault exam, Olson said.
The Green Mountain Care Board, which regulates hospitals, last week queried their two databases about hospital charges and insurance claims and arrived at the same conclusion.
“There is variation across institution in terms of what is charged for services,” said Michael Donofrio, an attorney for the Green Mountain Care Board.
These inconsistencies are part of what health care reform in Vermont and the nation aim to tackle.
Sears, a member of the 2013 study committee, said it was disturbing to learn about the discrepancies in charges for the exam.
“That’s sort of like, welcome to the wild world of hospital payment,” Olson said.
Hospitals have rough data but are in the process of verifying and don’t yet feel confident using it, she said.
Olson and Kenney said they will also work on a new “script” nurses can use with patients to encourage more victims to bill their insurance companies while still protecting their privacy.
Sen. Tim Ashe, D/P-Chittenden, proposed language that would prohibit hospitals from billing more than they charge Medicaid for the services.
“Our concern about Medicaid is that Medicaid pays well below cost,” Olson said.
On the other hand, charging the victims compensation fund the amount hospitals charge a private insurance company, such as Blue Cross Blue Shield, might not save the fund any money.
Olson and Kenney plan to discuss ideas for some sort of fee schedule for sexual assault exams and present a plan to the Senate Judiciary later this month.
If they don’t come up with a solution, the committee could use Ashe’s proposal or request a study, Sears said.
