How Surprise Medical Bills Are Impacting Health Plans

It should come as no surprise to any health plan that surprise medical bills are a serious issue in the United States. Along with our partner, Hanover Research, we recently commissioned a study that contributes to the increasing body of evidence demonstrating just how widespread the issue really is. We found that in a survey of more than 1,000 U.S. adults, 53% of respondents received an unexpected medical bill in the past 12 months. We know that all these unexpected bills are hurting more than just patients – they are also hurting health plans in very real, and very costly terms, including industry reputation, financial costs and member satisfaction.

Our survey dug into not only how widespread surprise medical bills are, but also how they’re impacting the wider health care industry.

Here are three big ways we found surprise medical bills are impacting health plans:

1. Your members are calling their health plan first seeking help and guidance. Of the individuals who reported receiving a surprise medical bill in our survey, 36% said that the first thing they did to resolve the issue was call their health plan.
2. Health plans are often a source of blame for surprise medical bills. Health insurance companies are often painted as the bad guy. Of the people who reported having an unexpected medical bill, 45% blame their insurer. Right or wrong, it impacts the trust and satisfaction people have with their plan.
3. Preventive care and regular check-ups are the first to go – and the long-term costs are high. According to our survey, consumers say that they have cut back on health care costs to their own detriment as a direct result of confusing or frustrating medical bills. Many report that they have gone without a routine check-up (40%), gone without a routine physical or other preventative health care screening (39%), or did not see a doctor when they (or a family member) were injured (39%). This can lead to a significant impact to the early identification or subsequent management of chronic and costly conditions such as heart disease, cancer and diabetes. These conditions cost substantially more money to treat in the long term.

So, how can health plans best support their members when it comes to surprise medical bills?

Luckily, while health care is confusing and frustrating, health plans are in a position to help. We know that engaging your members is an ongoing challenge, but here are a few ways to help your members minimize surprise medical bills.

1. Make health care rules easier to understand. People don’t always know if providers are in- or out-of-network. Provide easy-to-access and understandable information so people can select the right providers from the start. Guide them to providers that will provide quality care and reduce the chance for surprise later.
2. Have a plan for how to respond. Of survey respondents, 36% of those who received a surprise medical bill called their health plan first to resolve it. That is a lot of phone calls, but it presents an opportunity to help and show members all the resources available they can use to help avoid unexpected bills in the future. Having a clear policy in place for call center staff to help members through a surprise medical bill is an important first step. Providing claims information online can help members understand their charges and even point them to bill mediation support. Some plan call center reps regularly call providers with the member on the line to find a resolution in a single call. A win all around.
3. Know who you’re talking to. Understand your audience and the segment you are communicating with and speak their language. Test new ways to engage with them to help them understand – at the time they are seeking care – what tools they have available to them that can help reduce the likelihood of a surprise medical bill. Let them know the questions they can ask providers based on their unique situations, highlight and make clear the health care cost estimator tools that you offer, and keep your messaging consistent across channels. Ensuring that your tools provide as much personalized information as possible to each of your members is also key, but be careful not to go too far! [SEE CARING OR CREEPY: PERSONALIZATION IN HEALTH PLAN MARKETING].
4. Offer a comprehensive suite of tools and resources. Finding in-network providers is just one of the many daunting tasks members have in front of them. Offer tools that provide out-of-pocket costs, recommend convenient and cost-effective care options, and deliver experiences tailored to the unique health plan member and their benefits (including current deductible status, etc.). Giving accurate health care cost information and detailing what’s involved across a course of treatment (including all the providers, labs, and services that might be required, and what facilities and practitioners are covered through their health plan) will help members to see all that you offer to help them avoid surprise medical bills. [RELATED: HealthSparq increases treatments in unique timeline feature].
5. Make it easy to navigate. The health care system is a mystery for most Americans. The language, rules and processes are complicated. Help make it easy for people by guiding them through the process. Try using tricks and technologies from industries like retail and travel, so you can get to know your members and provide them with the tools to navigate health care with greater ease.

There is a lot to overcome when it comes to surprise medical bills, but positioning yourself to best support your members before, during and after a surprise medical bill occurs is a great place to start.

For even more great insights from our recent survey, see the infographic below. Interested in discussing further? Get in touch with our team today!