Sometimes health systems get caught in the middle between a patient and their insurance company. Usually, it’s over disputes about a medical bill. Often the disagreement is rooted in a patient’s misunderstanding of their coverage. But no matter the reason, it’s usually the health system’s brand that takes a hit through negative publicity.
Such issues are so common that NPR and Kaiser joined forces several years ago to present their “Bill of the Month” series, which features individual patient stories of surprising medical bills and why their bills are so high. These stories highlight several problems in how the healthcare industry tackles patient billing and collecting payments.
The Fine Print is Often Not So Fine
The latest example from NPR featured a 32-year old male who needed two-part jaw surgery to treat a history of migraines, jaw pain, and high blood pressure. His first surgery was in 2018. His out-of-pocket maximum for his Premera Blue Cross plan was $3,000. After a job switch, the patient assumed he had the same coverage. His new employer also offered coverage through Premera Blue Cross. However, his new coverage was different and the patient received a hospital bill for $27,119. He also owed additional money to the surgeon and anesthesiologist.
The patient was frustrated because he didn’t feel it was his responsibility to work through an 86-page member-benefit book to understand his coverage. While one could argue it was his responsibility, combing through and understanding an 86-page document isn’t exactly easy. His case was further complicated by the interpretation of essential benefits under the Affordable Care Act. Health insurance often caps jaw and dental procedures as these are not considered essential benefits under the ACA rules. The patient used a surgeon in his network, but relied on the surgeon’s office for the estimated co-pays and out-of-pocket.
Hospital Bear the Brunt of Bad Publicity for Medical Bills
The patient’s hospital decided to reduce his bill to $7,164 after NPR started investigating, likely to avoid more public backlash. Today, cost concerns are not insignificant. According to a 2020 analysis by the Kaiser Family Foundation, healthcare costs have risen much faster than wages in the last 10 years. Health insurance deductibles alone have increased by more than 110% over the last decade. Patients are struggling to keep up with these rising costs. In fact, one-third of all GoFundMe campaigns are for medical bills.
It’s no wonder Patientco’s 2021 State of the Financial Experience Report found that more patients skipped care because of cost concerns than COVID-19. Additionally, nearly half of patients revealed they need financial assistance on bills that exceed $500. The survey also found that price estimates without affordable payment options often drive patients away. Nearly 1 in 4 patients canceled or rescheduled their appointment after receiving a price estimate because of cost.
Revenue Cycle Tactics Influence Patient Loyalty
It’s time for health systems to realize the patient financial experience directly influences their brand’s reputation. Better revenue cycle tactics, like the ones we’ll discuss below, impact patient loyalty and ultimately, market share for your health system.
Treat each patient relationship in a personalized way.
Provide individually tailored communication and payment options to earn patients’ loyalty. Look for a partner like Patientco that can bring together multiple sources of healthcare data, along with patient engagement data. By doing so, it’s possible to tailor each interaction with patients. For example, Patientco can determine that a patient has a high deductible health plan and just received a large bill for their last hospital visit, but has not paid it. However, they have paid for prior bills from their primary care physician. These insights inform a more personalized messaging approach, where that patient may be offered a more flexible, monthly payment arrangement.
Making a payment should be easy and convenient.
Maximize convenience for every patient with mobile-friendly, digital-first billing communications, alongside self-service payment options to deliver a consumer-friendly financial experience. Leverage a partner (like Patientco) to send bills to patients through their preferred digital channel, whether that’s email or text. This supports a better patient experience and it supports your organization’s revenue cycle performance. For one, patients receive digital bills much faster than a traditional mailed paper statement, which means they will pay faster. Second, digital bills are more convenient because patients can interact with them on any device, regardless of their location or the time of day.
Keep it simple.
Support a better patient experience with one easy-to-understand statement that offers a single view of a patient’s payment responsibility. Translate medical billing codes into plain language to build patients’ trust. Present relevant EOB details and insurance information side-by-side within the bill pay experience to help patients truly understand their medical bills. By providing the right information at the right time, patients can more easily comprehend their health benefits, what their insurer contributed and what their out-of-pocket cost is. Patientco even offers clear definitions of medical terms and uses intuitive visuals that explain how the math works and breaks down the patient’s bill balance. This self-service approach helps patients feel in control and patients are more likely to pay when they trust their bill is accurate.
Be ready to address affordability concerns.
Make it easy for patients to pay their medical bill and move on with their day by offering a variety of online, self-service payment channels. Patients are often concerned about whether they can afford the cost of their care, so be sure to present affordable payment options, such as financing programs and monthly payment plans, with online enrollment. This gives your patients immediate access to affordable payment options that work for them. Meanwhile, this reduces the strain on your business office team’s bandwidth. Why? Because they no longer have to help patients sign up for more flexible payment arrangements.
Aggressive debt collection tactics and confusing medical bills damage a health system’s brand reputation. They also deteriorate patient trust. Patients should trust providers to do no harm, both physically and financially. Fortunately, with these strategies, finance and revenue cycle leaders can positively transform the patient financial experience while delivering meaningful ROI for their health system.
Meet the Author: John W. Mitchell’s job titles have ranged from sailor in the U.S. Navy (broadcast-journalist aboard an aircraft carrier) to COO and CEO for several hospitals. In 2009, HealthLeaders Media named John and his senior executive team the Top Leadership Team in Healthcare for turning around a 90-bed, regional Washington hospital. In 2012, he started his own business, SnowPack Public Relations. John is widely published as a freelance reporter and writer in the hospital, healthcare, and medical sectors. More recently, his projects include writing content on behalf of Patientco. John is also the author of the novel Medical Necessity (four stars on Amazon), and a commercially successful landscape and wildlife photographer.