Be upfront about out-of-pocket costs

| September 16, 2019

Be upfront about out-of-pocket costs

With an abundance of insurance plans offering different levels of coverage and cost-sharing, it’s no wonder patients are confused about how much they owe and what their plans cover. And when patients don’t understand how much they owe, they are reluctant to pay their bills. So it’s in the best interest of both the patient and your practice to be up front and clear about what their insurance plan covers, and how much they are responsible for.

Here are five simple steps to help your practice provide cost transparency:

Step 1: Preregister when scheduling appointments.

Preregistration is simple and effective. Staff members collect demographic and insurance information during scheduling so they can give patients accurate information about insurance coverage, deductibles and their financial responsibilities.

Step 2: Verify insurance benefits in advance.

Verify eligibility, benefits, copay, coinsurance and deductibles well before the patient arrives for their appointment.  Most practice management systems have this capability, but there are also stand-alone systems you can use. As a last resort, you can also get this information through individual payer websites.

Step 3: Provide accurate cost estimates up front.

Providing cost estimates to patients up front helps them avoid surprises after their visit. While it takes more work for the practice to develop these, it’s ultimately good for business.  Ideally, provide an estimate by phone before the appointment or, if that’s not possible, at registration.

In particular, provide patients with estimates for large ticket items like skin testing or allergy shots. Many insurance plans only partially pay for these services, so patients can be left with a big balance. At one large allergy practice, staff confirm all benefits in advance and call the patient prior to the appointment to discuss costs. They also do a consultation before skin testing so patients can decide not to be tested if cost is an issue. Doing this in advance prevents a large number of no-shows or last-minute cancellations.

Step 4: Offer options if a recommended treatment is not affordable.

Cost is an issue for many patients – even those with good insurance coverage. That’s why it’s so important to talk with patients about the costs of different treatment options to agree on one that’s both affordable and effective. While conversations like these may be uncomfortable, they are essential; there’s no point putting together a treatment plan the patient cannot afford and therefore won’t follow.

Step 5: Consider offering payment options.

Some allergy practices provide payment options, including payment plans for large ticket items. Others require upfront payments for allergy testing. Understanding your patient population and payer mix along with your accounts receivable levels will help you determine whether this would make sense for your practice. If you go this route, create a policy on payment options that can be shared with patients and staff.

“It’s best to be clear on payment requirements, both on the front end (before the visit) and the back end (after the visit),” said Kay Tyler, vice chair of the Practice Management Committee and CEO of Family Allergy & Asthma in Louisville, KY.  “For high deductible patients, we require an upfront payment, and may offer payment plans, based on need, that would require full payment of the balance within three to four months.”

To get more details on how to provide patients with cost transparency, view the College’s 15-minute educational module on patient financial counseling, which is part of our Allergy Office: Essentials series. Our Collections Toolkit provides additional information on this topic.