How Reducing Confusion Can Ease Medical Billing Stress for Employees

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Author: Guest Author

The following is a guest article by Brian Marsella, President at HPS/Paymedix.

Employees and employers agree that health care is a crucial benefit. Yet it’s the issue that causes the most stress, confusion and dissatisfaction among patients, employers and providers alike. 

Employees get endless bills, statements and notices, but the information rarely adds up. They don’t know what they owe and to whom. Nor do they understand what’s been covered by health insurance and what hasn’t. But this distress gives employers (and their plan providers) an opportunity to bring clarity and relief to their employees and their families by simplifying their Explanation of Benefits (EOBs) statements, answering their questions, and showing them how to navigate their plans. 

Employers and plan sponsors can play a much more significant role in helping employees get the right amount of care at the right time, and show them how to avoid costly mistakes. By reducing confusion and providing a patient-friendly path for those who need it, employees can be better informed and more in control of their medical expenses. 

How Billing Became a Broken System

The financial burden of health care payments has tilted significantly toward consumers, who now find themselves buried in a blizzard of EOBs and “what you owe” statements. It’s partly due to more employers offering higher-deductible health plans as a way to share cost increases with employees, resulting in higher out-of-pocket costs.

Employees on employer-sponsored plans also now have to deal with multiple invoices from different providers for deductibles and other payments. In fact, according to data from Health Payment Systems (HPS), the average U.S.  family can expect to receive approximately 125 pieces of mail each year related to health care billing.

The fragmented nature of health care payments, combined with a lack of coordination between employer plans and providers, has added to employee confusion around what they owe. Case in point: A recent study by Bend Financial found that 56% of Americans admitted to feeling “completely lost” when it came to understanding how their health insurance worked. Nearly half (47%) were confused about which procedures were covered and which services were considered out of network. 

“And all this confusion has real-world consequences on health care consumers. On average, respondents with current health care coverage estimated that they waste $111 per month on confusion over their health insurance plan,” the Bend report said.

The High Stakes

This confusion has negatively affected patients’ care. For example, the Bend study found that nearly 60% of consumers have put off scheduling an appointment with their caregivers, and 53% have put off getting a prescription filled due to uncertainty. As plan participants delay making necessary and preventive appointments, as well as not taking their medications, it inevitably leads to more expensive, emergent needs for care.

How Employers and Plan Sponsors Can Help 

Employers and plan sponsors can address the problem with a number of strategies. Employers can offer access to advocates within the plans, for example, that offer telephone hotlines that employees can call to answer health care benefit questions. 

Enhanced employee assistance programs (EAPs) can help employees avoid being billed for care by helping them resolve personal concerns before they turn into major health issues.

Most importantly, employers can leverage new technology platforms that create a simpler, friendly patient-centric EOB and billing experiences for employees. Today, insurers cram EOBs with every detail – from service codes to provider charges, allowed charges, owed amounts and remark codes – because of fears of being non-compliant with HIPAA, COBRA and host of other regulations, or face costly fines and penalties. Adding all the necessary compliance information to EOBs is the path of least resistance for plans, but much of this information isn’t relevant, is repetitive and drives employees further into confusion. They believe they can mitigate their regulatory risk by including every piece of information. But at the expense of making EOBs incomprehensible. 

The fact is EOBs do not have to contain every claim detail in order to be compliant. These new platforms simplify healthcare billing automatically stripping away unnecessary details and data, while delivering a single consolidated statement that eliminates confusion. Employees receive a single, simplified “super EOB” rather than multiple bills from multiple providers for each medical treatment. 

Some of these platforms also help employees deal with billing stress by giving the option to pay over time, regardless of their credit histories. All employees can be issued credit for all allowed charges up to their out-of-pocket max, regardless of their credit standing. The technology guarantees prompt full payment to healthcare providers in exchange for giving employees these more manageable repayment plans. Not only does a single, consolidated EOB increase employee satisfaction rates, it improves access to care by alleviating the burden of up-front, in-full payments and rigid collection processes from providers. They also shift the financial relationship away from providers and indiscriminate debt collection agencies by taking inefficiencies out of the system and streamline the payments process for all. 

As soon as a claim is adjudicated, the solution sends participating providers 100% of the in-network allowed amount. Employees get a single monthly summary of all their care regardless where they went to get it, and the typical blizzard of confusing paperwork goes away. 

The new solutions also benefit employers. They can automatically take care of enrolling all employees on behalf of the employer, even if some employees have less-favorable credit histories, for instance. All employees can be issued credit for all allowed charges up to their out-of-pocket max, regardless of their credit standing. Some solutions can also reduce the burden of health care costs for employees, increasing overall satisfaction with employer benefits. The key is for employers to find a platform that offers all employee charges up to their out-of-pocket limits as opposed to those that only provide limited credit for a portion of their expenses. 

Final Thoughts

Creating a good patient experience through better, patient-centric billing is a critical way to improve By reducing confusion and providing a payment path for consumers who need it, patients can be better informed, more in control of their medical expenses and, most importantly, reengaged.

About Brian Marsella

Brian Marsella is President at HPS/Paymedix. He has been in the healthcare industry for 30 years and has gained significant experience across many disciplines (underwriting, client management, sales, marketing, product, consulting, senior leadership, network management, board leadership and community engagement). His background has allowed him to develop an extensive network and understanding of how buying decisions are made by employers, carriers and consultants. His passion to enhance the way in which healthcare is evaluated, consumed and delivered is evident in the challenges he has taken on in the past and what he will be looking to impact moving forward.

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