Problematic Medical Bills Drive Consumers To Cut Back On Care

Posted on November 7, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

As we all know, patients and families are taking over responsibility for a steadily greater percentage of their healthcare costs over time. Not surprisingly, this can affect their medical decisions in negative ways. In fact, a new study has documented that their medical bills are confusing or unexpected, a patient may get overwhelmed and simply skip some forms of care entirely.

The study, which was conducted by Hanover Research and sponsored by HealthSparq, surveyed more than 1,000 Americans on their experiences with unexpected medical bills. The results should be unsettling to anyone in outpatient services, especially those in primary care.

Researchers found that more than half (53%) of respondents had received a surprise medical bill over the past 12 months. This included bills that were higher than expected (60%), for services they thought were covered by insurance but weren’t (62%) and from multiple providers when they expected to get just one (42%).

When faced with these frustrating billing situations, patients may drop out of their care routine to some extent. Many skip routine checkups (40%), routine health screenings (39%) or care for injuries (39%).

A substantial number of respondents (40%) conceded that they could’ve avoided such shocks by doing more to better understand their benefits and healthcare processes, in addition to blaming their insurers (45%) or their health providers (42%). Regardless, it appears that a large number didn’t know who was responsible for the problem, which doesn’t bode well for their future health behavior.

Look, everyone knows that offering an accurate estimate of patient financial liabilities could be a nightmare in some situations, particularly if insurance companies don’t play nicely with the billing department. It’s also true that in some cases, patients simply won’t be able to pay the bill regardless of how you present it, a problem you certainly can’t surmise on your own as a medical practice.

That being said, you can take a look at the bills your practice management system produces and get a sense whether they’re decipherable to those who don’t work within the organization. Even if the PM system does a good job of supporting your end of the process, that doesn’t mean it’s turning out bills that patients can use and understand.

Yes, arguably the most important thing a practice management system does is to support your claims process effectively, but seeing to it that patients aren’t overwhelmed by their bills is clearly a big deal too. Particularly under value-based care, you can’t afford to have them holding off on the services that will keep them well.