What happens when an unstoppable shift to healthcare consumerism meets an incumbent patient mindset? The frustration surrounding the rise of narrow networks is one example.
Narrow networks are nothing new, and the concept is pretty simple: less covered providers in your network for less cost on your insurance. No wonder more insurance carriers are offering and more patients are purchasing these types of coverage.
So why are patients getting so frustrated when they discover the costs of visiting out-of-network providers? Patients are blaming payers for building confusing networks. Payers are blaming the Affordable Care Act for making narrow network plans the most cost-effective coverage option. Providers just want to get paid for delivering quality care.
The truth is, patients, payers and providers (or collectively, “people”) share the responsibility of educating each other about the costs, benefits and realities of our healthcare system.
Patients should research their coverage options carefully and consider which providers are included in their network and what their financial responsibility will be with each option. Given that the majority of Americans don’t understand most insurance terms, this is an issue that will require long-term education initiatives in the future.
Payers should be clear about what each type of coverage provides and does not provide as well as the patient’s financial responsibility before enrollment occurs. Keep in mind the limitations of patient understanding mentioned above. When a misunderstanding occurs, everyone loses.
Providers should communicate clearly and empathetically with patients about their financial obligations, before, during and after care delivery based on each patient’s coverage. Just because a patient has purchased insurance does not mean they understand their duty to co-pay the hospital or pay more for out-of-network care. Clear explanation and a smooth payment process will ensure maximum revenue capture for the provider.
Healthcare is complicated, most of all to those outside of the industry, but narrow networks don’t have to be. No matter which category of “people” you fall into, will you do your part to make narrow networks a little less rocket science today?