If it seems like many more patients are presenting with high-deductible insurance plans, there are some hard data to back it up.

Almost half (47%) of commercially insured patients younger than age 65 years now carry a high-deductible plan (defined as at least $1,350 for individual coverage, or $2,700 for family coverage), according to the authors of a recent study.1

“What we’re seeing with high-deductible health plans aligns pretty well with this. This is a huge population to accommodate,” says Austin Brandt, director of revenue cycle solutions at Bluetree Network, a health IT consulting firm. Even so, the total dollars paid by patients remains a relatively small portion of total A/R for most hospitals. “It hasn’t completely jolted us out of the ‘treat now and bill later’ mentality,” Brandt observes.

High deductibles are negatively affecting hospitals’ financials, Brandt reports. Many patients cannot pay them, so the accounts end up written off or become bad debt. “The truth is, there’s so much room for improvement that almost anything that encourages collections earlier in the revenue cycle is a step in the right direction,” Brandt explains.

Patients with high deductibles often need an expert’s help. Ideally, this means a highly trained financial counselor who handles such cases all day. “No matter the size of the organization, there are always more patients than financial counseling staff can proactively reach out to,” Brandt laments.

That is where front-end staff come in. Registrars can pave the way for the eventual discussion with a financial counselor. “Every time you schedule or register a patient is an opportunity to discuss payment expectations and available assistance,” Brandt offers. When the patient does meet with the financial counselor, the basics are covered already. The discussion can focus on available options, such as zero-interest bank loans.

“By guaranteeing the loans and eliminating credit checks, you open up funding to a huge population of patients,” Brandt notes. This is beyond the scope of the average registrar, but any registrar can at least start the conversation. Putting the right tools in the hands of financial counselors also is important.

“They need to prioritize patients through different measurements, like propensity to pay, to maximize their effectiveness,” Brandt adds.


  1. Martinez ME, et al. Health insurance coverage: Early release of estimates from the national health interview survey, 2018. National Center for Health Statistics. Available at: http://bit.ly/38D4rse.