High Deductible Health Plans, coinsurance, copays, noncovered services. The list seems endless of the reasons healthcare providers have been collecting more cash from patients than from insurance plans in recent years.
Why is it hard?
None of us plan to get ill. Accidents happen. We find ourselves lying in the emergency room bed. After I have been treated, the friendly registrar comes in, verifies my information and asks for my insurance card. They enter my info in their system and voilà, “Sir, you have a $6000 deductible, of which you have met $1000 so far this year. We estimate your ER visit total will be $3200 but with your plan’s discount, your patient responsibility will be $2200. How would you like to pay for that today? We take Visa, MC, Amex, & Discover.” I take out my my HSA card and hand it to this nice person. They complete the transaction and I am discharged.
We all know this is rarely the case.
- Sometimes we don’t even meet a registrar, especially in a busy ER.
- They may or may not ask for my insurance card, assuming I still have the same insurance from 5 years ago.
- They don’t verify my insurance even if they collect it.
- If they do, they don’t understand or explain my benefits to me.
- They don’t know how or have not been provided with a means to estimate my ER visit
- They don’t ask for any money during an ER visit, afraid they may violate EMTALA rules
- I probably won’t have a means to pay
- If not, they don’t offer me a payment plan or charity care application.
But doesn’t technology solve this problem?
I can have the best of technology to verify insurance and benefits, provide patient estimates, and collect the cash, but none of that technology will have solved any of the eight failure points above. All eight are either operational or cultural issues that have to be addressed before any implementation of technology will make an impact to the cash I put in the bank.
The technology we need does not substitute for, but rather supports the operational and cultural changes we make. Why do we continually struggle with technology adoption and adherence that leads to the promised ROI? Because we are addicted to the idea of the easy fix. During technology implementations, we need to spend as much if not more time on the operational and cultural changes as we do on the technology itself.