The Ins and Outs of Health Insurance: Handling High-Deductible Plans

We are in an era of high-deductible health plans. According to U.S. News & World Report, the number of uninsured adults in the U.S. stayed steady in 2017 at about 13%, while the number of people with high-deductible plans went up. At least one study defined a high-deductible plan as having an annual deductible of $1,300 or more for a single person and $2,500 or more for a family. And according to data pulled from the U.S. Centers for Disease Control and Prevention, the percentage of adults under the age of 65 who had high-deductible plans rose from 39.4% in 2016 to 43.2% in 2017.

What are the issues?

Low-deductible health plans tend to have extremely expensive monthly premiums. As a result, an increasing number of patients are coming into physicians’ offices with high-deductible plans. For routine care, this is unlikely to be a big problem — but for expensive procedures, many patients may be unaware of just how much of the procedure fee they’ll have to cover themselves.

This places a burden on physicians and their practices to alert the patient to the likelihood of a high bill. Physicians also need to put rules in place to assure that they do actually get paid for their services.

What’s the best approach?

Overall, the best solution is for your medical practice to create an appropriate financial policy. Pricing transparency should be a priority: Patients should be educated on their own policies and different payment approaches should be available. Here are some pointers for handling high-deductible health plans:

Encourage preventive health care. Most insurance policies completely cover annual checkups, screening and immunizations. Encourage patients to take advantage of preventive health care to minimize future health issues.

Educate patients on their insurance. The majority of patients probably don’t know exactly what’s in their health insurance policies, let alone the difference between co-pays, co-insurance, deductibles or other common terms. It might be a good idea to include a glossary of terms in your orientation paperwork.

Be clear about service costs. As much as possible, be transparent about prices and be aware that patients with high-deductible coverage are likely to comparison shop. Discuss your payment policies with patients and staff. When it comes to high-priced procedures, make patients aware of how much will be their responsibility.

Collect co-pays or co-insurance at the visit. Make it part of your policy, state it in patient communications, and make sure your staff understands it as well.

Offer payment options. Obviously, immediate payment is welcome, whether cash, check or credit card. While you may want to discount fees for immediate-paying customers, in many states it is illegal to offer these discounts — and many insurance contracts prohibit them. But immediate payment is unlikely for high-cost procedures, so it also may make sense to offer the option of payment plans.

How can you make it easy?

High-deductible health plans are unlikely to go away anytime soon. So it’s important for physicians and their staffs, who are on the front lines, to make it as easy as possible for patients to pay their bills — and obtain high-quality health care at the same time.

© 2018