Patients as Payers: The New Reality

This is an excerpt from the ebook “The Patient Costs Playbook: When High Deductibles Turn Patients Into Payers”. Click here to read the complete ebook.

High deductibles are a burden for patients and providers.

In the U.S., the average annual deductible for a single person with an employer-provided health plan increased more than 250% between 2006 and 2018. This has shifted the burden on patients to become payers and on doctors to become debt collectors.

Why Doctors Are Worried

Now that an estimated 35% of their revenue comes directly from patients, doctors in private practice say getting reimbursed is their top concern for staying in business. Like other business owners, they collect a salary only after covering monthly expenses. But even group practitioners and hospitals aren’t immune from worry about reimbursement.

For any type of practice, having too many patients who can’t (or just don’t) pay their bills isn’t profitable—or sustainable. And the higher a patient’s deductible, the less likely they are to pay any portion of their bill. That’s why high deductibles are creating financial hardships for patients and healthcare providers alike.

The Solution: Zero in on Patient Financial Clearance

Among patients who don’t pay their medical bills, a recent survey identified the top reasons as unknowing visits to out-of-network providers (32%), claims denials (26%), and high deductibles (26%). Collecting insurance information and assessing a patient’s ability to pay before treatment can help eliminate denials, and give them a heads-up about out-of-network costs.

Your first step as a provider: Educate staff about the importance of collecting insurance information—and payments—up front. Connect the dots between patients paying their bills and your ability to make payroll. Then, coordinate across teams to implement a financial clearance process like the one outlined below for every patient touchpoint.

Scheduling Staff

Role: Collect Information

When patients call to schedule appointments, require schedulers to collect personal, insurance, and relevant procedural information such as: 

• Patient name
• Date of birth
• Insurance company name
• Name of primary insurance holder
• Policy number and group ID
• Diagnosis codes for specific procedures
• Authorization or referral numbers
• Copy of physician’s’ orders

Pre-Registration Staff

Role: Verify & Document Information

Verifying insurance coverage collected at the time of scheduling will help eliminate denials, which decreases out-of-pocket expenses for patients—and increases your likelihood of getting paid. Pre-registration staff should contact insurance companies to verify:

• Policy number and group ID
• Effective dates of coverage
• Deductibles, copays, and non-covered amounts
• Benefits or coverage for specific procedures
• Medical necessity (if patient is relying on Medicare)

Registration Staff 

Role: Verify Identity & Collect Payment

At check in, registration staff serve dual roles: as gatekeepers who ensure your practice gets paid, and as guides who help patients understand what they owe, how to pay, and where to seek financial assistance if they need it.

For same-day and emergency appointments, registration staff should follow the pre-registration checklist above. Otherwise, they can simply verify:

• Patient’s identity and date of birth (from a government ID)
• Mailing address and telephone number
• Insurance information

They should also collect:

• Copies of insurance cards
• Copies of physician’s’ orders and authorization or referral numbers
• Upfront payments for insurance deductibles, coinsurance, copays, and a target percentage of non-covered charges
• Applications for financial assistance or extended payment plans (if patients are experiencing financial hardship and you have programs to help)

Clinical Staff

Role: Adhere, Communicate, & Refer

At every patient appointment, your clinical staff should adhere to the procedure(s) for which benefits have been verified. When changes are necessary, clinicians should quickly communicate to billing staff which services were performed.

When patients have questions about the cost of services, clinical staff should be prepared to refer patients to front-office and financial staff. Additionally, if your practice has an online portal where patients can access medical records and make payments, equip doctors with a fact sheet they can share with patients about how to access and use the system. 

The Antidote to High Deductibles Is Lower Denials

While healthcare providers can’t help patients improve their insurance coverage or decrease their deductibles, you can help eliminate denials by verifying insurance coverage before treatment. This informs patients what they owe in advance, so they’re not surprised by your bill, and are more likely to pay.

To learn how to save time by automating eligibility and benefits verification, download our ebook, “The Patient Costs Playbook: When High Deductibles Turn Patients Into Payers.”

Readers also read:

Giving Patients Your Best Estimate

Making it Easy for Patients to Pay