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Educating Patients on Health Insurance Benefits


Spending a few minutes explaining health insurance benefits to patients prior to the appointment should become a requirement.

In a continuation from last week's article "Why Should Medical Billers Get All of the Blame?" I would like to touch on patient education this week.

I say it often in my blogs that you must identify patient benefits prior to the patient coming in to the medical office. I think everyone knows this, so we'll take it a step further. If you verify the patient's benefits and then choose not to share that information with him, you are setting yourself up for trouble. Of course it is the patient's responsibility to know and understand his benefits, but let's be honest, do you know and understand your benefits? Do you have a calendar year plan, a policy plan, a benefit plan, or a fiscal year type of plan? Even being in the medical billing industry, my personal health plan changes, and often I'm unaware of the changes. Maybe it is time to give your patients a break?

So, when you have your patient come into the office a few minutes early to fill out any remaining paperwork, this is the time for your staff to complete an "Explanation of Benefits," detailing her insurance benefits and go over it in detail with her. You can actually have it filled out prior to the patient's arrival and ready to go before the appointment begins. This is not a job for the faint at heart, as there is the possibility that it may cause a scene. Many patients are unpleasantly surprised when they find out the amount of their cost sharing. So training the right person to explain what treatment will be covered and what the patient's cost share will be (according to the insurance company) is key. The staff member must really understand what she is talking about and remember that most patients likely do not understand the "secret" jargon of medical professionals and insurance companies.

I've said in the past, with all of these new ACA plans emerging every year, even the brokers who sell the plans to the patients do not understand all of the nuances. Unfortunately, it ends up being the provider and his staff who gets that job, like it or not.

Don't think you want to venture into that lake of tar? Think again. By sitting with the patient and taking the time to present the information thoughtfully and thoroughly, you are telling the patient that "they are worth it" in your eyes. You have set the tone for the entire patient experience. You and the billing department are a team. Yes, you are. There is no "us" and "them" and once you accept this, you will be providing a much better customer-service experience for patients.

Now that the patient has been seen by the provider and he understands what fiscal responsibility will be, you have taken away the potential angry reaction directed at your front office or the billing department - that simply pushes the claims out to the clearinghouses and insurance companies. Your patient will get the bill (if you have not already collected that cost share) and write the check, go online and pay, or call you with a credit card. As it should be.

It seems like such a simple solution: just communicate with the patient. Yet, so many practices skip this most important step. It only takes a few minutes if you use a staffer who is well versed in understanding various insurance plans, but the payoff is worth it.

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