Health insurance plans have become more complicated over the last few years. This not only means patients benefits include in and out of network deductibles (and they can be pretty high), greater patient responsibility (20%) is not the norm, it can be 30,40,50%, and patients may or may not have coverage month to month and chances are they change their plan from year to year. Changing their plan means a change in their benefits. When they walk into the office they may not tell you that nothing has changed and they have not received an updated card.
Checking eligibility and benefits is extremely important.
Now more than ever. Knowing a patient’s benefits can mean the difference between you getting that patient portion paid or not and the patient feeling blindsided or not. With out of network providers, being transparent about cost of care to the patient is not just a responsibility of the practice but also eliminates the surprise of receiving a patient bill and being angry at how much they are being billed for.
It’s like if you went to the store and the salesperson convinced you to buy a pair of shoes because they are one of a kind, the finest leather, will last, look great on you and will give others the impression that you are successful and well dressed. The salesperson puts the shoes in a bag and hand them to you and shakes your hand and says “Thank you for your purchase! Enjoy!” The next day you wear those shoes to work and everyone is complimenting you and your ego is feeling pretty good.
Then a couple of weeks after that you get a bill for $2,000. “What for” you wonder. “Oh! For those shoes.” While you stare at the bill you start to get angry “OH! THOSE SHOES. FOR THOSE SHOES?! They’re not worth $2000! What a rip off! What a jerk that salesperson is. Sleazy salesperson conned me.”
This is what patients are thinking. Now what happens is one of the following things
- Patient pays and disappears, never comes back to the office
- They don’t pay and never come back
- They pay and their trust in you is breached
Don’t assumethe patients who pay and come back are happy. Chances are if they get another bill without any heads up from the office, that will be their last visit because they are already on alert now. Majority of the patients will never come back. That’s what you have to worry about. It costs time and money to acquire a new patient. It costs time and money to lose a patient, plus any online reviews they decide to write about you.
RULE#1 – Have an open and honest discussion with patients about their financial responsibility before they are actually responsible
Many health insurances and clearinghouses provide a cost estimator. Simply enter the CPT code and the patient’s info and you will get the contracted rates and unmet deductible and co-insurance amounts. You will also know if a code is a non-covered service.
RULE#2 – Arm yourself with tools to help you better estimate patient responsibility
Create a policy on Payment Plans so when a patient cannot afford to pay the total amount in one shot, they have options. This payment plan could include automatic recurring payments as well as an upfront payment with the balance divided over 3-6 months
RULE#2 – One person, not multiple people in the practice should have these conversations with patients
A DocComply client, Dr. R. didn’t like to get into the daily details of his practice and because he wasn’t the most approachable person, his staff avoided bothering him unless it was essential. Some patients were paying their balances and most were not. No one was following up with patients so the patients didn’t feel a sense of urgency to pay.
The lost money was in the thousands, possibly even tens of thousands... Per year! Since Dr. R was making good money, he never had to pay attention to this problem but he knew it was a problem. He did not realize how big of a problem it was until DocComply took over his billing. It wasn’t long before we uncovered the problem but it wasn’t until we started getting candid feedback from patients that we had a clear picture of it all.
So we explained to him “Dr. R, are you happy with your patient collections?” “No, I am not. In the past when I have quested the collections I was given all kinds of excuses but never a real answers. I don’t know why, but I never was.” “Let’s talk about the problem here and no sugar coating. You’re not only losing tens of thousands of dollars a year, you’re new-to-established patient ratio is extremely low.
They like you but they see the EOB and freak out. They see how much you are charging and how much they could be billed and they are blindsided. When someone is blindsided, they lose trust, they feel like they were conned, like they were lied to. They either wait for a bill, then call angry to say they can’t pay or won’t pay, or they never call and they never come back. Even the ones who are angry and call, they may come back once but never again. Because they are afraid they are going to be paying you a lot of money that they can’t afford to pay. Also by not having a proper system in place for collecting on patient responsibility, patients take advantage. They’re not going to look at an EOB and just send you the money. They wait for a bill. They wait to see what happens. It’s not that they don’t intend to pay, it’s just well we are used to receiving a bill and then paying. Does this make sense Dr. R?” “It makes complete sense. I just can’t believe I let things go this far.” “So what if you did, only thing matters now is that a system is put in place so that it never happens again.”
Don’t lose out on money, it’s hard earned. Review what you are doing today, acknowledge what is working and what is not, come up with new policies and procedures, and remember to review them every few months and adjust as needed. Following this simple formula improved Dr. R’s patient collections and a pleasant side effect, patient and staff were happier!
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