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Are patients confused by coverage? Educate
Misunderstandings are common
Patients might have bought an insurance policy with lower premiums and higher deductibles, but lack understanding of what those mean. This part of the job is one of the hardest for patient access staff, according to Joan S. Braveman, director of patient access and financial services at Tallahassee (FL) Memorial HealthCare.
"We have seen a policy that has a $10,000 deductible," she says. "People may hear that, but it's not until you say to them, 'Your insurance company will not pay a penny until you pay $10,000,' that it sinks in. We have actually seen an increase in bad debt on patient liability because of that."
Braveman says that she believes insurance companies do their members a disservice by failing to educate them adequately. "A lot of times, people don't truly understand that they have to pay that amount out of pocket before their insurance kicks in," she says.
Staff members often are put in the unpleasant position of educating staff about their insurance coverage, says Braveman, and they find it hard to be the bearer of bad news. In general, she says, patients are turning to Access staff to be more informed about their coverage and responsibilities.
"In the old days, everybody had a Blue Cross type of policy and a 20% copay. You knew you would have to pay for 20% of whatever Blue Cross allowed, and that was it," says Braveman. "Now every single plan is different, even within a single payer, based on who your employer is."
Patients are taking more initiative to learn what they will owe, reports Braveman. Recently, she received a call from a case manager working with a patient recently diagnosed with cancer. "He will be needing radiation treatment and wanted some idea of how much he would owe out of pocket," she says.
Looking forward, Braveman envisions a time when this information would be more readily available to patients directly through the hospital's web site. Ideally, she says, patients would be able to put in a procedure code which would tell them, based on their plan, how much they will owe. "That's many light years away," says Braveman. "One of the biggest challenges is that patients don't know the correct codes. It can get very technical, with different codes for a CT scan for the brain or abdomen, or with or without contrast."