High-deductible plans leading providers to change billing procedures

As more health insurance plans feature high deductibles, many providers are revamping procedures to increase the odds of getting reimbursed by asking patients to pay their share of the bill up front or helping them to explore  payment options.

“These days, if a patient doesn’t pay the bill, the hospital is going to feel it,” Matt Moore, director of product management for patient access solutions for RelayHealth, recently explained.

As a new study by The Commonwealth Fund shows, 25% of privately insured adult Americans can’t afford to pay their medical bills. More specifically, 43% of all of respondents and 51% of low- and moderate-income adults said it is difficult or impossible to pay their deductibles.

But what if there are no patients to bill or with whom to even discuss payment options? The Commonwealth Fund survey shows that 40% of people with high deductibles relative to their incomes either “had not gone to the doctor when they were sick, had not gotten a preventive care test, skipped a recommended follow-up test, or had not gotten specialist care they needed because of their deductible.”

Even relatively affluent states aren’t immune to this phenomenon. A new survey from the Massachusetts Center for Health Information and Analysis shows that while the Bay State’s 3.6% un-insurance rate is well below the 9.2% average for the entire U.S., one in six respondents “reported having an unmet need for health care due to cost.”

Of those Massachusetts respondents without health insurance, more than half (54.8%) said cost was the key factor in their lack of coverage.

When asked which strategies they used to lower the families’ health care costs, nearly one-third of respondents reported that “they and their families were trying to stay healthier, going without needed health care, or switching to a lower cost health insurance plan,” according to the survey’s report.

Trying to stay healthier is a great idea; going without needed healthcare, not so much. And when staying healthier and foregoing basic healthcare aren’t possible, consumers typically turn to emergency rooms (often for non-emergency reasons). This is turn drives up costs for hospitals and healthcare networks, much of which won’t be compensated. It’s a vicious cycle.

The changes transforming the healthcare industry and challenging provider revenue cycles have been occurring against the backdrop of a recovering economy. Remember, however, a downturn would make it even harder for consumers to cover their increasing share of medical bills.

Thus it’s critical that providers continue to tighten up their revenue cycle processes, conduct education and outreach to patients, and use analytics to drive population health initiatives.

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