Meet David Galbraith. David is a successful business owner and generally healthy individual who has required relatively minimal extended healthcare in the course of his adulthood. That’s why he found his recent experience with an outpatient surgery quite jarring—and not very patient friendly at all.
When David exhibited symptoms, he was referred to a respected physician who accommodated a prompt appointment and swiftly booked a procedure. David, familiar with the high deductible of his insurance coverage, was pleased to take care of his situation in short order without concern regarding cost. After all, he understood his coverage, as he’d chosen it himself, and he’d asked the right questions in that process. Other than being told when and where to report and how to physically prepare for his simple operation, he received no other counsel from the healthcare provider, particularly regarding costs and payments.
The procedure went extremely well. “The whole thing took no more than 45 minutes,” David reports. “I arrived at the hospital at 7 a.m. and was home by 10:15.”
Perhaps that’s why it was so shocking when he received a bill for over $12,000 three weeks later. Though the dollar figure was unexpectedly high, David was most concerned that he’d been given no warning beforehand and that the bill received was so poorly presented. The language was cryptic, and while the statement was very detailed (“$57 for a hospital gown?!”), the information was not presented logically.
“There were excessive details, yet none of it really made sense to me as a patient,” David explains. “It was difficult to understand...and left me asking why (individual line items) cost so much and what could I have done differently to keep costs down.”
Ultimately, David was forced to spend valuable time on the phone with his insurance company and the provider trying to make sense of the bill and reconcile it accordingly. All told, he’s spent far more time dealing with billing than he did receiving care.
“Now that more of us are on high deductible plans, there needs to be simplified bills for patients,” he summarizes. “When we get a bill we don’t understand, it is both time consuming and frustrating to straighten everything out.”
For David, the frustration isn’t so much about the costs of the care (“It’s okay to pay fair market value…”). He’s most distraught by how poorly the information was conveyed. From obvious lack of financial counsel prior to the procedure to the baffling bill that showed up in the mail three weeks later, he experienced gaping holes in the communications process. Those holes would likely have been filled with a simple pre-admission conversation about billing and a patient friendly statement with clear summarization and key information called out.
Certainly, the walk in David’s shoes is well worth the journey, as his experience is an all too familiar one. Though many of us in our industry are genuinely committed to the idea of patient friendly billing standards, they are not always put into practice. We remain tethered to outdated modes of billing while the trends have catapulted forward. Here are three “Do Now” steps we should all employ to avoid putting patients in adversarial roles come billing time.
- Pre-admission Counsel and Estimations: It’s extremely helpful to provide patients a road map so they understand the financial aspects of their care before it occurs. It should be standard policy that all patients be counseled regarding payment responsibility and cost estimates based on their health coverage prior to admission.
- Online Pre-registration: By pre-registering patients online, providers have the opportunity to vet coverage issues, make determinations about charity care cases and offer patients more detail regarding potential payment responsibilities. This approach requires system updates, but it is well worth the effort. If your organization is not presently set up for online pre-registration, take this as your cue to pursue this solution.
- Friendly Billing Statements and Options: Apply the HFMA standards for patient friendly billing to your statements immediately. Redesign the statements to be more patient-friendly, with key information highlighted and details appropriately summarized for more simple comprehension. Give patients more ways to pay by offering online account management.
At Emdeon, we understand that patients who are confused about their financial responsibilities are more likely to pick up the phone and call your billing department instead of picking up their pen to write a check for payment. That’s why developing a clear and concise, patient-friendly billing statement is important for your bottom line. Call 877.EMDEON.6 (877.363.3666) or visit us online to discover how Emdeon ExpressBill Services can help improve cash flow at your organization.
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One Patient's Surprising Post-Op Pain: A $12,000 Bill
