A woman is charged $22,000 for stitches and scar repair after being bitten by a dog. A man gets hit with a $30,000 bill for ACL reconstruction surgery. People around the country receive Covid-19 test bills ranging from a few dollars to more than $1,000—and to make things worse, they aren’t supposed to receive a bill, anyway.
Surprise billing in healthcare is a nightmare, and it happens all the time. It takes a severe emotional toll, as well as a monetary one. Nearly 30 million Americans are uninsured, but having insurance can still leave people vulnerable as they spend countless hours submitting claims, providing documentation, following up on claims, and fighting charges they can’t understand. Even those with robust coverage are facing fees they did not expect. Meanwhile, insurance deductibles and out-of-pocket medical expenses are increasing at staggering rates, and 84% of U.S. adults are worried about paying for their healthcare costs. Surprise billing compounds frustration and stress by failing to disclose all costs and fees upfront—or worse, coming in after the patient has already paid a bill.
Sometimes medical codes are the culprit in surprise billing. For example, a doctor may bill for a visit, but then orders additional tests or procedures to be done at an outside laboratory or facility which submits a separate claim. This additional billing can lead to confusion, frustration, and perhaps unpaid bills all around.
No one should have to deal with this, particularly during a health crisis when people are often at their most vulnerable.
Trust is a huge problem in our fundamentally broken system, where surprise bills number in the millions each year: A 2020 poll revealed that 2 in 3 adults say they worry about unexpected medical bills more than affording other household expenses. Among privately insured patients, an estimated 1 in 5 emergency claims and 1 in 6 in-network hospitalizations include at least one bill that’s out-of-network. And although things may be starting to shift for the better with new legislation, in the form of price transparency and the No Surprises Act, a recent study found that only 5.6% of hospitals were fully compliant with price transparency regulations, while another found that only 1 in 10 patients are aware that hospitals are now required to post prices online.
As we begin to emerge from the COVID-19 pandemic, many patients are still facing financial uncertainty caused by unemployment and other hardships. Their willingness to pay their bills remains high, but their ability to do so has declined. And with hospitals and health systems coping with the financial fallout from COVID-19, cash flow is more important than ever.
In the status quo way of doing things, everybody loses.
Complying with the measures put forth by price transparency regulations and the No Surprises Act is a great start—and absolutely essential—but it isn’t enough. The larger challenge is inserting some much-needed compassion and empathy into the healthcare billing process, ensuring that patients feel supported by their providers during uncertain and stressful times.
Compassionate billing—the practice of healthcare providers supporting consumers with empathy and understanding throughout the billing process—empowers patients to take control of their financial obligations, arrange payment plans, and find other ways to pay, ultimately improving health outcomes for patients while payers and providers meet their revenue goals.
These days, communicating effectively with consumers around payments is all about personalizing their experiences and conveying kindness and understanding every step of the way. Making this simple shift can help turn a potentially stressful and antagonistic situation into one that helps consumers feel cared for and eager to engage. Think like best-in-class digital brands such as Amazon and Netflix, which meet consumers where they are.
Healthcare organizations should work closely with consumers on their financial obligations, using modern ways of engaging and meeting people where they are. Fortunately, there are some impactful ways to put compassionate billing into action—and they might just surprise you in a good way:
Offer flexible payment plan options. Our research has found that the size of monthly payments toward a plan does not negatively impact the collection rate, suggesting that patients want to cover their obligations and choose amounts that fit their monthly budget. By offering more options, patients and providers win.
Extend billing cycles. This might sound counter-intuitive, but we find that it’s actually beneficial in terms of revenue. For example, extending billing cycles from 120 days to 150 days can make a significant difference to some patients. Moreover, it will result in fewer accounts sent to collections.
Encourage digital engagement across every channel. Sending supportive bill reminders via multiple digital communication channels, such as text and email, encourages patients to self-serve online. That means fewer administrative hassles for you.
Reward prompt payment behavior. It’s positive reinforcement, and it’s smart. Prompt-pay discounts can help patients act early by making care costs more affordable. And discounts offered to patients as soon as bills drop are more likely to accelerate payment (rather than offering them mid-billing cycle).
Automate rote contact center workflows. Enabling self-service for basic tasks, such as payment plan set up, and updating insurance, can resolve bills more quickly, and eliminate stress on both the patient and provider side that results from an inundated call center.
Employ existing communication channels. Use patient portals and monthly statements as an opportunity to remind patients that their care and well-being matter most above all. These small yet powerful gestures are also opportunities to educate patients about resources available to them, such as flexible payment options.
Of course, billing is only one aspect of a vast system in need of modernization, but it’s heartening to keep in mind that billing can actually be a pleasant “surprise” when done with compassion, patience, and understanding. By treating consumers as people with unique circumstances, we can support their needs, meet revenue goals, and collectively take a big leap forward into a better healthcare system.
About Florian Otto, CEO and Co-Founder of Cedar
An accomplished entrepreneur and former physician, Florian Otto now drives growth and sets overall direction across all facets of Cedar’s operations. Prior to founding Cedar, Florian was an executive at Zocdoc where he drove the commercial adoption of the platform. Florian also founded a daily deal company in Brazil (ClubeUrbano) that was eventually acquired by Groupon. After the acquisition, he became Chief Executive Officer of Groupon Brazil, growing the company to one of Groupon’s top three international markets. Florian began his business career as a strategy consultant at McKinsey & Company within their healthcare practice. Florian holds a M.D., D.D.S. and PhD from the University of Freiburg, Germany.