In 2018, the Center for Disease Control found that 43% of individuals with private health plans have a high deductible health plan (HDHP). An HDHP means an individual plan holder is responsible for at least the first $1,350 of their healthcare expenses each year, often with an additional co-insurance requirement until they reach their out-of-pocket maximum. The deductible increases to $2,700 for families on an HDHP whose 2016 average total out-of-pocket expenses totaled $4,300.
As patients shoulder more of the financial burden from their health care, they are asking for an understanding of costs before they get treatment. Health systems are responding to this demand by making estimates more accessible, but with the risk that the estimated amount could be much different than the final bill. We won’t discuss the reasons the estimate can vary so much (there are many); instead, we’ll focus on what to do with an estimate even if it’s likely to be wrong. To discuss this strategy further, let’s put these estimates into two categories.
The easy estimates
These estimates are more simple or certain in nature. Often, they are for common or elective procedures, or for a patient not billing insurance. For example, a health system will have a higher certainty around the billed charges for cosmetic skin or vein therapy, and can make the estimate more readily available for the patient. Centura Health, a 17-hospital health system in Colorado and Kansas, publishes prices for 100+ procedures online that allow self-pay patients to select the facility and their procedure and view the to-the-dollar cost ahead of time.
The hard estimates
These estimates are more complex in nature. Multiple payers and contracts are in play, other bills are in adjudication that will affect the remaining deductible, or the coding of the same procedure could vary significantly from physician to physician or from the nature of the patient’s diagnosis. Any one of these factors will affect the patient’s responsibility when the bill is finalized. With more expensive procedures a change to the estimate could mean a swing in patient responsibility of thousands of dollars.
Here are two strategies a health system can employ to maintain a great patient experience despite the variability of the estimate:
1. Communicate to the patient throughout the process
One reason patients get frustrated with health care bills is that the final billed amount, much like my tax return each year, always seems like a surprise. Health systems have an opportunity to take away the surprise by communicating with the patient throughout the life of the estimate. VisitPay is a dynamic consumer engagement platform that can be leveraged for this.
For example, a system can build a rule to automatically notify the patient through email or text any time the estimated patient responsibility changes before the procedure or while the bill is adjudicating. VisitPay can also be configured to put the patient into a work queue for a customer service representative to call in the event the estimate changes by a predefined amount or percent.
2. Give patients payment options that meet their needs
Financial situations vary dramatically from patient to patient, so one-size-fits-all financial policies don’t work. Some patients, like an expecting mother, may want to begin paying on their estimate before they give birth. Others may want to make a down payment now but wait to set up a payment plan until the bill is finalized. Once again, VisitPay is a tool that can be leveraged for this.
At the time of providing an estimate, a health system using VisitPay can access consumer insights including the patient’s propensity to pay, income level, and current balance. These insights can be used to give each patient the financial offer that best meets their needs.
A patient with a lower balance or higher propensity to pay may benefit the most from a discounted pay-in-full offer. A patient with a high balance may benefit the most from a reasonable monthly payment plan that will automatically adjust in duration, without intervention from customer service staff, as the patient’s responsibility is finalized.
As long as uncertainty exists in the estimate process, health systems can use meaningful communication and one-for-one financial offers to maintain a great patient experience.
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