Over the last few years patients have shouldered more of the cost of their health care, particularly in high deductible and coinsurance benefit designs. The numbered of uninsured persons who must pay for all of their medical care has also increased. Since health care providers typically have provided services and then billed the patients and/or insurers, the increase in payments from individuals has left them vulnerable to bad debt expense and added to their practice costs as they chase down overdue and unpaid bills. A number of health plans and independent vendors have developed solutions designed to identify what a patient will owe at the time of service and many physicians, hospitals and other providers are insisting on payment before the patient leaves the office. A Wall Street Journal article details these developments and the impacts on patients. (WSJ Article)
While the technology and information flow is improving, it is always difficult to be completely certain about the amount the patient is responsible for paying. In some cases providers are just using estimates, which might lead to patient overcharges. Even when the patient charge is calculated through a real-time interaction with a payer, the information in the insurer’s database may not be fully up to date. There may also be problems if the patient has multiple sources of coverage.
Another impact is that patients are placed in the position of having to decide if they can afford the care. This may be good if it leads to better decisions about seeking only appropriate care, but patients don’t often have all the information they need to make those judgments. Being asked to pay at the time of service might lead to delays in seeking needed care. It is also likely that patients being asked to pay more at the time of service will heighten pressure for health reform, which for these patients may simply mean they would like to be told that someone else is going to pay for their health care.