Help consumers understand their coverage


spring 2020, 36 million people lost their jobs, the highest unemployment rate since the Great Depression. An analysis predicted that 26 million people lose employer’s health coverage during the pandemic. Most of them (79%) likely qualified for subsidized coverage, whether through Medicaid or insurance exchanges. Some of these consumers could have switched to their spouse’s insurance coverage.

That’s a significant number of people who could navigate new coverage in 2021. Given that 38% of consumers who have insurance only “somewhat” understand what expenses are covered by their health plan – and about one in four understands it ‘just a little’, ” according to the survey – it is important for those responsible for the healthcare revenue cycle to ask, “How do we help consumers understand their coverage as early as possible in their meeting?”

Here are four approaches that could allay consumer concerns and boost financial commitment.

Contact patients who request estimates before they plan the service

Two out of three consumers worry that they will not be able to pay their medical bills this year. This is one reason why hospitals should proactively engage consumers looking for price estimates in discussions about personal care costs – the information consumers need most. Without a clear understanding of their financial responsibility for post-insurance care, consumers can defer care on the basis of estimate alone. It’s a decision that could prolong their concerns about their health. It could also make existing health problems more serious and more expensive to treat.

Proactively help patients understand their coverage

According to the consumer survey, only 28% of consumers surveyed say they have discussed the health expenses covered by their health plan with their provider. With hospitals still experiencing a decrease in volumes In their emergency departments, operating rooms and inpatient units during the pandemic, revenue cycle teams play a critical role in giving consumers the information they need to make informed decisions about their care. Make sure consumers understand terms like deductible, authorized amount and maximum pocket, and set these conditions on billing statements as well. Taking the time to guide patients through the expected benefits not only makes them more confident in pursuing a plan of care, but also creates a sense of goodwill towards the provider.

Closing the transparency gap

Two in three people would shop around for care, and 38% have already done so, according to the consumer survey. Yet even with a new price transparency rule that went into effect in January, 30% of suppliers are not compliant with either aspect of the rule, from posting fees for 300 purchasable services in a consumer-friendly format to sharing their payor-negotiated rates or the cash price offered to paying patients themselves. This presents a bad image to cost-conscious consumers. In 2021, it is important for suppliers to make it easy for consumers to find their list of fees. Provide the charges in a user-friendly format and clearly indicate that the charges are different from the post-insurance reimbursable charges. Equally important: give individuals a point of contact for financial discussions with patients. These steps allow consumers to make an informed decision when purchasing health services. It also reduces financial anxiety when complex discussions about the cost of care are needed.

Provide flexible payment options

Some patients may be ill-prepared, financially, to cover the cost of more intensive care. In situations like these, the self-paying balances approach with an emphasis on transparency and payment flexibility alleviates patients’ financial concerns and allows them to continue seeking needed care without delay. During the pandemic, for example, 43% of providers are experiencing an increase in requests for payment plans. For some populations, interest in affordable and flexible payment options is high: 41% of consumers surveyed say it is “very important” that providers offer zero-interest or low-interest payment plans, including 49% of Gen Xers and 45% of Millennials. About three in five families want to discuss payment plans or financing before care is provided.

Rethinking post-pandemic financial care

The long-term effects of the pandemic on insurance coverage require a highly compassionate and highly communicative approach to patient financial engagement. Taking the time to educate consumers on what their insurance covers, how much they can expect to pay out of pocket, and the payment options available that meet their needs is a great place to start.

Mark Spinner is President and CEO of AccessOne.

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