Back in the days when patients did not owe much more than a $20 copay, offering a payment plan would seem more an attempt at humor than a necessary solution. But with $5,000 deductibles the new norm, it is a different story.

“High-deductible plans, coupled with an increasing uninsured population, make payment plans essential,” says Yolanda Miller, CHAM, director of patient access, preregistration services, and financial counseling at Floyd Medical Center in Rome, GA.

With soaring out-of-pocket costs, as many good options as possible are needed. “One size does not fit all,” Miller says. “Having a variety of methods is good practice.”

The first step is to nail down the dollar amount the patient will owe. “Our team has an estimation tool to determine amounts not covered by insurance,” Miller notes.

The tool validates eligibility and patient benefits. It also factors in contractual rates negotiated with payers. Registrars then have in their hands the dollar amount that will not be covered by insurance. “The rep can then print an estimate letter to use for having the financial liability conversation with the patient,” Miller says.

Payment plans are offered preservice as a part of the preregistration workflow if the patient will have a balance and cannot pay the entire amount. Two options are presented:

  • If the patient can pay the balance in four or fewer payments, registrars offer an in-house, four-month payment plan at zero interest;
  • If the patient requires more than four months to pay the balance, registrars help the patient apply for a zero-interest loan through an external vendor.

Some patients state that they cannot pay any amount. If so, registrars offer a financial assistance application. “Based on income, household size, and assets, the patient can receive discounts up to 100% write-off,” Miller explains.

In the ED, the same process is used, but with different timing. The medical screening examination must be completed to comply with the Emergency Medical Treatment and Labor Act (EMTALA). Only then can registrars request payment.

“The same payment plan options are offered to the patient,” Miller adds.

Registrars also offer payment plans in ancillary areas at the time of registration for nonscheduled services. “Patient financial services also offer the payment plans as a part of billing and follow-up process,” Miller says.

Previously, staff struggled with how to collect high-dollar amounts. Often, they were reluctant to even bring up the topic of money because they were unsure how much the person would owe.

“Having the estimate letter as a tool has proven to be empowering for the staff,” Miller says. “Having that document to review when asking for payment gives the staff confidence.” Point-of-service collections started in 2016. Since then, ED collections more than doubled.

“We are seeing more patients of all types taking advantage of the zero percent finance option,” Miller reports. One potential pitfall with payment plans is the length of time it takes to complete them.

“It is important to be consistent with the plans offered to avoid the long-term minimal payment plans that contribute to account aging,” Miller says. When possible, registrars guide patients to a shorter-term option. “Also, financial assistance may be a viable option for the patient,” Miller adds. “This should not be overlooked when discussing payment plans.”