A Collision Course; Confusion in Healthcare

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June 25, 2013 by Rick B

Almost every article you read about the current state of healthcare contains a paragraph where the word “healthcare” and “confusion” collide.

Patient confusion over how their insurance interacts with their providers is not necessarily new, but has jumped into the spotlight in recent years. Higher premiums, deductibles, coinsurance, and co-pays are making it more difficult for consumers to understand their health plan. Patients are paying higher monthly premiums, only to find out that only a fraction of their service was actually covered by their insurer.

Take the case of Jenny as an example:

iStock_000013733658Small Jenny

Jenny is a 38 year old female; she is married and has a 7 year old daughter, a 4 year old son, and a 4 month old baby boy. 

Jenny works full time and her husband, Jeff, is a stay-at-home dad.  Jenny has her family enrolled in her employer-sponsored health plan with a prominent national insurer. 

Currently, Jenny’s portion of the premium is $350 per month. She is not happy about the monthly cost, but likes the fact her deductible is only $1,000.  

Jenny’s 4 yr. old son recently broke his arm falling off the jungle gym and the medical bills are piling up quickly.  Jenny looks at the bills as they arrive and does some quick accounting of what she will owe in coinsurance.  She is not overly worried about the bills generated by the broken arm, because she knows she already paid her $1,000 deductible back in January for the delivery of her baby and another $1,000 for her husband’s vasectomy in March.

Fast forward 6 weeks, Jenny is outraged by an unexpected bill for $1,050 for the services her son received on his broken arm.  Who is Jenny mad at? The provider. Why? Because they sent the bill.

Should Jenny have known each family member has a $1,000 deductible? Probably. Is the provider responsible for educating patients on their individual health insurance? No. Will this prevent Jenny from “shooting the messenger”? Probably not.

There is only one way to prevent your patients from being surprised by the bill you send them.  You must proactively communicate.  The earlier in the billing process you can engage the patient, the better.  For instance, alerting someone of their expected out-of-pocket expense prior to point of service would be better than sending them a bill 3 weeks after the date of service.

Engaging patients early in the billing process gets them involved in the process, sets expectations, will lead to more payments, faster payments, and increased patient satisfaction.

Proactively communicate, communicate, communicate!

For ideas on how to improve your revenue cycle, visit www.unitedcreditservice.com


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