The term "surprise medical bills" has gained traction in recent years as employees encounter the healthcare system in various ways. Various legislative proposals have also aimed at curbing the impact to patients, some the result of manipulating the system others just plain errors. Certainly COVID has added a layer of nuance as all the players sort their way through the pandemic.
Sources of surprise bills:
1. Out of network - An individual has surgery at a facility in their insurance contract network with a surgeon also known in network. The anesthesiologist, who often is not known until surgery, happens to be out of network. Post-surgery, the patient receives a bill for out of network cost share (deductible).
2. Emergency - An individual is in a car accident, either in capacitated or unable to transport themselves to the hospital. Ambulance arrives to pick-up the individual and transport them to the hospital. After recovery, the patient receives an out of network bill from the ambulance provider.
3. Errors - Depending on the source, it is estimated that medical bills have errors 20%-30% of the time. Those errors could be related to the demographic information, policy information, charges, or cost shares.
A business leader called me asking about COVID testing, and whether their insurance plan paid for testing at 100%. An employee received a bill for the test and wondered if she should pay it. I asked that they send me the bill to take a look. After receiving the bill and contacting the insurer, it turns out the medical provider did not submit the charge for the test, so naturally it wasn't paid. Oddly, they only billed an office visit, which was paid. The bill from the provider looked as if all charges were submitted and the remaining balance was due from the employee/patient. We resolved the issue by requesting the provider resubmit all charges for adjudication.
Leaders can support their employees a variety of ways to minimize the impact of surprise billing:
- Provide clarity on network limits and resources to "shop" services employees may need services
- Provide education/training on how to review all of their bills and identify any potential errors
- Encourage the employee to ask for help if they are unsure before paying
- Provide contact information for best contacts if they have a question
- Partner with brokers and service providers who are easily accessibly, monitor claims and advocate on the plan and employee's behalf
Addressing medical bills retro-actively can be complicated. Getting ahead of the potential problem helps to ease the employee's mind and improve the experience. These tips can be part of a people-centered plan design to support employee health literacy.