Self-Pay Revenue Management

3 min read

Working to Stop Surprise Billing

August 8, 2019 - 8:00 AM

Surprise medical bills are big business. A recent survey suggests 57% of Americans have received a medical bill they expected their insurance to cover.

They happen for a variety of reasons. Often, they happen when a patient receives care from an out-of-network provider at their in-network facility.

This can happen even when the patient isn't made aware beforehand. The patient assumes their insurance will cover the cost of the procedure. It's taking place at an in-network facility, after all. But what they don't know is they're using an out-of-network physician for part of the procedure. Until they're slapped with the bill, that is.

One thing is clear:

Surprise medical bills are unfair — and we need to put a stop to them.

Thankfully, Congress seems to agree. Momentum is building on both sides of the table — with both Democrats and Republicans both campaigning for change.

So what's the solution?

Senators are pushing for legislative changes to put a stop to the practice — but this isn't enough.

That's because the problem goes much deeper than the laws used to govern insurance companies and providers. The blame lies within the system itself. It thrives when patients aren't informed. It depends on them having little power over their care — because this is when providers and insurers can exploit them for profit.

Instead of passing new laws, we need to deconstruct the system. We need to address some fundamental problems in the pricing of procedures and the way they communicate with patients.

We need to empower patients with knowledge.

The first step in overcoming surprise medical bills is to remove the "surprise" aspect of them.
Instead of leaving patients to discover the true cost of their treatment when it's too late to do anything about it, we need to arm them with knowledge and set expectations ahead of time.
Real-time pricing is one way to start.

It is notoriously difficult to get accurate pricing for a procedure ahead of schedule. Several online calculators can help patients with this — but none are particularly accurate.
This is because the prices vary so much between providers, insurance companies, and areas. There are so many variables that affect the price of care; it's impossible to adopt a one-size-fits-all approach.

Real-time pricing would enable patients to see the variations in cost — between their provider options — before they receive care.

This is the first logical step. Over time, the variation in the price will level out as patients are empowered to choose the most affordable options available to them.

Health care providers and insurers already have the data and systems they need to facilitate this — so why aren't we starting there?

But isn't this what the government is trying to achieve with transparent pricing?

Not exactly.

Washington has passed legislation requiring facilities to share their prices on their website. The intention behind this is good — to reduce surprise medical bills — but the reality is that these efforts will not be effective.

Making prices available on the website is not enough — because it's not transparent enough.
For patients to be able to use this information, they would also need to understand how medical billing and coding work.

The majority of people simply don't know how to do this.

As well as making the prices available — they need to be easy to interpret and understand.
Making real-time pricing available — in an easy-to-understand format — will make it easier for patients to compare providers and make the choice that's right for them.

It's time to pass the control back to consumers — and demand more from our insurers and health care providers.

Written by Emerald

Post a Comment