2021 continues with the trend of patients being increasingly responsible for medical bills, in large part, due to the rise of high deductible plans. However, less than half of that patient responsibility is ever paid in full, and at the end of the day, the doctors and their practices are the ones who suffer. This may relate to trust. Do patients even trust their medical bills?
Recent research says they don’t.
10 patients who do not use Inbox Health were recruited to answer questions in an interview format. In addition, evidence was taken from a sample of 100 tickets* submitted by patients through the Inbox Health patient engagement platform to better understand what patients think when faced with a patient statement. Patients’ ages ranged from 30 to 84 across a variety of demographics.
The main reason for distrust in medical bills comes from the perception that patients believe their health insurance should have covered the charges.
50% of patient inquiries are insurance-related questions
Patients interviewed said they did not want to make a payment immediately after receiving a bill because they doubt the accuracy of medical bills and their insurance coverage.
"I hesitate to pay when I am not really sure if the insurance company has thoroughly looked through the bill. I spend some time analyzing them. I don’t pay the bill until I confirm they have gone to my insurance." - John, patient
“If there is something overcharged, I don’t pay. Sometimes the insurance doesn't catch up with my bill. I almost think my doctor is ‘out to get me’. I investigate every bill when they don’t look right. I always make a couple phone calls.” - Jennifer, patient
Patients have a non-trusting relationship with medical bills and health insurance coverage from the get-go, with many expecting billing errors and ambiguous procedure explanations from their providers and insurance companies. More than half of the patients’ questions were on insurance coverage and payments. The most frequently asked question via ticket submission was: “ Why doesn’t my insurance cover this bill?” Health insurance policies change consistently, and patients may not always be aware of these changes. Not to mention, payment reason (PR) codes, deductibles, and in-network coverage vary by insurance provider.
The second reason why patients don’t trust their medical bills is because of confusion about line items and payment reason codes.
Line item and billing enterprise questions result in 10% of patient inquiries
Nothing is more frustrating than being charged for something without knowing where it came from, the reason for it, or the date of service. Unfortunately, this happens quite often in the healthcare industry. Unlike grocery shopping receipts, medical bills are difficult to match the line item on the bill with a service received. Each line item the patient sees on their bill has a one to five-digit billing code which was created to classify and explain which services exactly have been performed by their provider. For example, HST TYPE III PRTBLE MON MIN 4 CH (TC MOD - (G0399-TC), is a line item one could find on a medical bill. Unless patients are experienced health care workers, they are unlikely to understand that code or know what that means to them and will require further explanation.
Finally, medical bills** aren’t easy to read and understand, and this makes matters worse.
This leads to additional phone calls and emails to the provider’s biller - taking more time away from them, when instead, all of this information could have been made available to the patient in the first place with plain language, and more distinct information.
Patients are becoming more aware that they have a bigger payment responsibility when it comes to healthcare, and they want to be informed. They don’t trust their medical bills and insurance companies instinctively, and therefore, their questions revolve around coverage amounts, explanation of PR codes, and line items, resulting in a higher volume of inquiries to the medical biller.
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*Inbox Health has access to over 60 thousand patient tickets from 2020 and over 35 million unique patient interactions.
**Inbox Health’s Product team takes all this research evidence into design consideration. For example, to explain the bill thoroughly, they break down the charge, cost reduction, insurance payment, and patient payment information into a linear fashion. Coverage explanation is also displayed to describe why the insurance paid or did not pay for each procedure. Therefore, patients are able to see all the information they need immediately, within a single invoice.