One of the most delicate subjects medical office staff must discuss with patients is what to expect for their financial responsibility. The insurance trend in past years has consisted of skyrocketing deductibles, co-insurance percentages, and out of pocket limits.
The best advice I have for the situation is: be honest.
Honesty promotes trust.
No matter the industry, two keys to having a successful business/customer relationship are honesty and trust.
This is especially true in the healthcare industry.
It is important to identify the expected patient expenses as early as possible in the “treatment” timeline and
inform the patient.
Billing professionals understand that even though that concept is simple, getting accurate information can be like maneuvering a maze.
We may need assistance from clinical staff in providing what treatment/procedures are expected. For initial examinations this is not typically available and “planned” treatment can often be changed.
We may encounter a payer with less than straight forward benefit information. I remember a payer with a “hospital/surgical” plan that would cover the outpatient hospital charges for radiation oncology, not the physician charges, but only if related to a surgery.
Shavara’s Iridium Suite medical billing software has an integrated Real Time Eligibility function that enables confirmation of patient eligibility as well as most of the basic benefits within a matter of seconds. The response can also be used to create your patient and is kept permanently in the system for future reference.
Once you have an idea of what the bill could be, now the time for discussion with the patient has come. I believe most people understand they will have some type of out of pocket expense, however for some complex treatments like radiation oncology, they are often shocked at the extensiveness and its associated cost.
Step 1 – How much may it cost?
Give a written breakdown of their benefits and how they will work with the service provided. Some services may be subject to a flatco-payment and others deductible and co-insurance. Explain how those expenses may or may not apply to their out of pocket maximum.
Step 2 – Can they pay in full or will they payment plan?
As mentioned above, I feel people want to pay for services, but due to circumstances it can be a financial burden. Listen to the patient. Discuss what is possible for them to pay and set up agreed upon payment arrangements.
Step 3 – If payments seem to be out of the question, what are other options?
Recommend local and national charities or aid programs that offer assistance in your community or for specific illnesses/diseases. With radiation oncology, I have had patients receive help from the Leukemia and Lymphoma Society and the Susan G. Komen Foundation. Your local hospital may be a good resource for locating additional options in your area.
Like this article? Want more? Subscribe to our Medical Billing Blog.
