Although patients know the importance of healthcare and insurance, most do not understand their coverage and benefits. Nitin Chhoda explains how patients misunderstand insurance, and why it is important to openly communicate with them in order to avoid financial struggle.
The nature of health care insurance of a healthcare practice management in the United States leaves most patients pretty confused about what they need and what they are entitled to.
For example, even patients who have health care insurance may not benefit from their insurance most of the time.
If a deductible is built into the insurance plan, the patient will end up paying for most of their doctor visits every year. The only time they benefit from having insurance is when a serious accident occurs or they are diagnosed with a serious illness.
A Patient’s Perspective
From the patient’s perspective, the health care insurance system is confusing and always more expensive than they expect. A co-pay that is required, perhaps $20 for a visit or 20% of the bill, might come as a surprise to a patient that doesn’t understand their policy.
Even worse is when the patient does not understand the deductible of his/her health care insurance. They may look at their policy, find out that a certain treatment is covered, and not realize that they must pay the entire cost because they haven’t met their deductible limit.
For Clinicians and Medical Practices, Misunderstandings Can Mean Lost Revenue
Let’s consider a patient who does not understand the deductible, but they want to go to a dermatologist to test an unusual mark on their skin. They wonder if it’s skin cancer or just a mole, so they figure out that this kind of test is covered by their health care insurance, as long as they get a referral.
First they go to a general practitioner who is covered by the particular health care insurance company. They pay for that visit, or perhaps just a co-pay, and get their referral.
But then they have an appointment with a dermatologist and tests are done to determine what the skin growth is. This is all pretty expensive and the bill comes to $1000.
At first both the dermatologist’s office and the patient believe that the patient must only pay the co-pay of 20%, which is $200 because of his/her health care insurance.
If the patient has a $3000 deductible that they have not reached, a chain of events ensues, which causes expense, wasted time, and stress for the patient and the medical staff.
First, the medical billing staff will bill the health care insurance company for the amount they typically pay, in this case $800. But the claim will be rejected because the deductible has not been met. Then the medical office has to bill the patient that $800 – an amount the patient is not expecting to pay.
A Realization
From the patient’s perspective of health care insurance, this is a terrible realization. From the practice’s perspective, this has been a waste of time and now they do not know if they will be paid for services already rendered. It is quite possible that the patient cannot afford to pay that $800. Even the $200 was probably a bit of a bummer at least.
The truth is that the patient made the right choices in making a health care insurance.
If that skin growth was skin cancer, it should be tested and removed. If they leave it alone, they may get seriously ill and have to undergo much more expensive and intensive treatments. But they are discouraged from taking those first steps because it is so costly.
