How advisors can end confusing health care billing

Benefits brokers and consultants deliver enormous value to employers by helping their employees become smarter consumers of health care. But that value could be threatened by growing employee dissatisfaction with an overly complicated health care billing system.

Many employees are inundated by endless medical bills and notices, but the information rarely makes sense. They don’t know what they owe or to whom. Nor do they understand what is and is not covered by their employer’s benefits plan. Somewhere within the mountain of medical messages they receive each month is useful information that could help them understand what they actually owe. But most information is disaggregated, repetitive and often not useful when it comes to understanding their payment situation. In turn, employee stress, confusion and dissatisfaction spreads among the workforce, creating challenges for employee retention and wellbeing.

But new developments in payment platforms are giving benefit consultants fresh opportunities to solve their clients’ insurance and health care billing issues. By making health care billing less confusing and more cost-effective for all, these new platforms can help turn employees into better informed consumers who are more in control of their medical expenses. More importantly, employees become more engaged and motivated in their own health care journey.

Understanding the underlying causes

 Benefits advisors have been in the unfortunate position of having to offer plans that shift more of the financial burden of health care payments towards employees. Meanwhile, employers are increasingly offering high-deductible plans to share cost increases with employees, leading to growing out-of-pocket contributions on behalf of the employee.

Employees now have to deal with multiple invoices from different providers for deductibles and other payments, in addition to invoices from their health plan. They are buried in a blizzard of EOBs and “what you owe” statements.  In fact, data from Health Payment Systems (HPS) found that the average American family can expect to receive approximately 125 pieces of mail each year related to health care billing.

Worse yet, this confusion is negatively impacting employees’ overall health. Employers worry that their workforce isn’t getting the care they need. For example, a Bend Financial study found that nearly 60% of consumers have canceled or postponed an appointment with their caregivers, and 53% have put off getting a prescription filled, due to uncertainty. Employers are understandably concerned that, as their employees delay making necessary appointments or don’t take their medications, it will lead to more expensive, emergent needs for care.

Brokers and consultants can help fix the broken system by leveraging new platforms to create a patient-centric experience across the entire billing lifecycle. It starts with using a health care payment financing platform that guarantees prompt full-payment to health care providers while offering manageable repayment plans to employees.  The platforms shift the financial relationship away from providers and indiscriminate debt collection agencies to partners who take inefficiencies out of the system and streamline the payments process for all.

The cost of the employee’s invoice is paid to the provider upfront, with the platform then establishing a payment relationship with the patient. For example, employers can offer employees manageable repayment plans for all allowed in-network, out-of-pocket charges up to a patient’s maximum out-of-pocket amount. Or they can receive credit for out-of-pocket costs at low to no interest and construct a payment schedule that fits their needs. Most importantly, they guarantee payment to providers and credit to all employees, regardless of their credit record.

Brokers can automatically take care of enrolling all employees on behalf of the employer, even if, for instance, some employees have less-favorable credit histories. All employees can be issued credit for all allowed charges up to their out-of-pocket max.

This new dynamic means that employees will no longer be chased by collections or be demanded payment before delivering care. As soon as a claim is adjudicated, participating providers get 100% of the in-network allowed amount. Employees get a single monthly summary of all their care regardless of where they went to get it, and the typical blizzard of confusing paperwork goes away.

 Final thoughts

 New health care payments financing platforms offer benefits advisors and consultants an opportunity to be heroes for their employer clients. By guaranteeing payments to providers and offering understandable statements and flexible payments for all employees, these new tools are changing the way people access, use, and pay for health care.

The solutions can also reduce the burden of health care costs for employees, increasing overall satisfaction with employer benefits.

Brian Marsella is president, PayMedix.