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High deductible plans’ impact on your patients and practice

November 28, 2017

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Until recently, health care insurance deductibles with many plans were considerably lower than they are now. Accelerated partly by the Affordable Care Act, employers have enthusiastically implemented high deductible plans to lower the increased costs of mandated new employee coverage, with 29 percent of covered employees enrolled in HDHP plans in 2016. 

  • Employees and other health care consumers are now required to assume a greater share of costs, often putting families under heavy financial burdens.  A recent Kaiser Family Foundation study showed that 43 percent of HDHP patients postponed or skipped physician-recommended tests and procedures due to higher costs.
  • HDHP have added to the complexity of the physician-patient relationship with the need for providers and billing staff to clarify with patients coverage limits and costs. Barriers to care occur when patients may forego needed treatment or tests, possibly leading to the need for more extensive (and expensive) care than would have been necessary had the patient’s treatment not been interrupted.
  • Additionally, providers have seen an increase in past-due payments by HDHP patients unable to afford high out-of-pocket fees and related costs. This is the case with Boston Children’s Hospital, which reported $65.2 unpaid collectibles in FY 2016, doubled from 2012.
  • If there are no other affordable plan alternatives available to consumers, either in the workplace or independently, they may have no choice than to continue with their HDHP. This means that practices must adapt to the realities of their markets and be willing to either work with patients in managing care costs or risk being faced with a declining practice – either from lost unpaid revenues or losing established patients.

Suggestions for improving payment outcome while retaining HDHP-impacted patients

    • First have a policy in place for handling pre-payment or other means of collecting co-pays and deductibles, especially for costlier procedures. Alert patients up front that payment will be required once eligibility and estimated benefits have been confirmed.
    • Improved communication between the physician and patient concerning the patient’s insurance plans and coverage may help avoid missing needed exams and treatment and improve transparency about services and pricing. By explaining the need for certain procedures and other treatments, providers may reduce at-risk patients skipping {{cta(‘fe2c2b8c-b789-4047-bdd3-999242ee9278′,’justifyright’)}}needed treatment and thereby increasing the possibility of additional and longer hospitalizations or avoidable complications.
    • Sending explanatory emails, postcards or personalized letters can help educate patients that some tests, such as wellness exams or cancer screenings, may not be subject to a deductible 
and therefore need not be avoided or postponed.
  • Offering a variety of co-pay and deductible payment options, including requesting up-front deductible payment, as well as keeping a credit card on file to debit payments, are becoming standard collection practices by many providers.
  • Some offices have tried to waive the co-pay or deductible payments for those with financial problems but as more and more patients fall under the HDHP umbrella, this is no longer a viable financial option for most practices.

How can working with a medical billing service help?

Working with an established medical billing service company such as M-Scribe can help practices determine what services are covered with no applicable deductible, and under which circumstances the patient may need to have payment arrangements made either in advance or after the insurer’s explanation of benefits is sent. M-Scribe stays current on the latest changes in federal, state and insurance industry reimbursement regulations.

Investing the time for a no-cost evaluation of your practice’s revenue cycle management with one of M-Scribe’s experienced representatives can pay dividends in identifying and resolving problem areas that may be impacting revenue. Call 888-727-4234 or email them today to learn how to increase revenues without losing patients to HDHP.


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