Transparency of healthcare prices have been in the headlines recently:
— In June, the Trump Administration issued an executive order requiring hospitals to post price information for basic services and facilitate access to information about out-of-pocket costs before procedures.
— Last year, states such as New Jersey, Virginia and Oregon passed legislation to protect consumers from unexpected costs such as surprise-bills from hospitals. In Texas, a court declared that patients involved in hospital lawsuits could access the fees paid by various insurers to determine a fair and reasonable price for services.
— A recent survey found that 92% of healthcare consumers want to know their financial obligations before a provider visit and 74% are confused by EOBs provided by their insurance company.
The common thread through the above? Patients are demanding better information about the price of healthcare and are increasingly viewing medicine as a consumable good.
This patient-as-consumer mindset presents many new challenges to the healthcare provider. Below are some practical solutions to help your patients better understand costs and what they may be paying out-of-pocket:
Many patients appreciate a clear and concise financial policy. We recommend the policy include an explanation of out-of-pocket expenses such as co-pays, coinsurance and deductibles; although many patients are aware of these terms, few truly understand the differences. Some practices may also want to consider providing a brief explanation about negotiated rates with insurance companies so that patients can understand adjustments to fees. It is much easier to talk about bills when everyone is using the same language.
There is no doubt that it can be tricky to provide estimates before office visits and procedures. However, it is in everyone’s best interest if patients are prepared for future expenses. If possible, create some standard estimates for common visits and procedures for patients without insurance. Providing estimates for patients with insurance can be much more difficult because of varying reimbursement rates. In these situations, some practices employ estimate software that is a database of negotiated fees and approximate out-of-pocket expense for patients.
Either in your financial policy or on your patient statement, point-out that paying attention to EOBs from payers is important, and if a claim is unexpectedly denied, to contact the insurance company. There is little a provider’s office can do to help a patient understand his or her EOB. However, patients can be encouraged to call their insurance company for EOB explanations – which ultimately will educate patients about the reimbursement process.
Most statements have room for patient messages – and certain patient questions can be avoided if messages address common queries. For example, some practices may want to use the space to point out that the balance due is the amount left after insurance has been billed, or that if insurance information needs to be updated, it is the responsibility of the patient to forward the new insurance details.
Take a hard look at your statement format and evaluate if there is anything you can do to make it easier for your patient to understand. Can language be simplified? For example, rather than using the term ‘adjustment’ use ‘insurance discount,’ or replace the term ‘coinsurance’ with an easier-to-understand ‘patient pays.’ Color can also bring attention to amounts patients owe.
The patient-as-consumer mindset is here to stay. Practices that see this as an opportunity to partner with patients to help them understand their financial obligations will ultimately develop stronger patient-provider relationships. Ultimately, these relationships will ensure the longevity of your practice as healthcare reimbursement evolves.
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