If you are frustrated by how confused patients can be about their insurance, and by the conflicts this confusion often leads to (especially about patient balances), you have good reason. Insurance is provided by employers, who theoretically should be able to explain it (it’s an important part of employee compensation, after all). And it’s offered and managed by insurance companies, who set and enforce the terms.
There seem to be several good ways, logical ways to get information about insurance rules. So why do many patients misunderstand how it works?
A few things are obvious. One is that health insurance can be very complicated. (It is complicated for those of us who work with it every day, even.) And the training and information patients have access to from their employers and insurers is simply not clear or accessible enough for many patients and many situations.
This gap shouldn’t be your problem. But it ultimately becomes your problem, since you’ll have to deal with patients’ confusion and corresponding reluctance to pay.
All of which is a long way of saying that helping patients understand how their insurance works may not be something you should have to do, but it is something you’re better off doing. And the earlier in the relationship you start the education process, the better. The clearer patients are on their financial responsibility before they receive care, the less likely they will be surprised by a large balance they didn’t expect to owe.
There is an old saw in marketing about how you have to repeat a message seven to ten times before anyone really absorbs it. The seven to ten is not regarded as a scientific analysis by anyone. But the idea that you have to repeat things, usually more often than you expect, and ideally via different media, is well accepted. (There’s a reason you see and hear advertising by the same companies in different places and via different channels.)
To this end, we often suggest to medical practices that they have some explanatory material at the front desk that covers common insurance issues–things like what may or may not be covered, or things that may or may not be “free” as a preventive service, for example. The purpose of this is not to make it unnecessary to explain insurance by phone or in person. The idea is to give the patient more than one opportunity to hear and understand.
I recently had an oral surgery procedure, and I was impressed by a document that was handed to me beforehand. It was not the only time I heard about costs or insurance. The staff and the surgeon made a point of explaining at several points along the way. But having something to read while in the reception area was useful. With his permission, here’s a look at part of his handout:
I didn’t include the entire thing, but wanted to share the gist of it. It’s best if you come up with materials that reflect your own practice brand. But this surgery practice’s goal of addressing confusion before it happens is worth emulating.
I recommend a multi-pronged approach that can include:
- FAQ and articles on your website
- Training of staff who set appointments, so that they can begin the process of explaining insurance (e.g., while verifying it real-time)
- Documents at the front desk
- Training of front desk staff, availability of billing staff to help answer questions in the office
- Reminder content: deliver via portal, email, in statements
Remember the purposes of these efforts. By making insurance less scary and confusing, you’ll reinforce your caring relationship with patients. And by addressing confusion early in the process, you’ll reduce the risk of a financial disagreement or unpleasant surprise that will undermine that relationship. Bringing these issues up early means you’ll also have time to refer a patient to their employer or insurer if they’re unsure about what amount they will or should be personally responsible for before they incur the obligation.
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