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Insurance doesn’t always protect patients from medical debt. Here’s how providers can help.


In a world of high deductibles and copays, health insurance offers less protection from medical debt than it did a generation ago.

Medical debt affects patients: ©Amazing Studios -

Medical debt affects patients: ©Amazing Studios -

In a world of high deductibles and copays, health insurance offers less protection from medical debt than it did a generation ago.

Although a large majority of the population has health insurance, more than one-in-five U.S. adults with health insurance have medical debt, according to a recent report from the Kaiser Family Foundation (KFF).

For example, among insured adults who experienced medical debt in the prior year, 41% had a medical problem but, due to cost, did not go to a doctor or clinic. Additionally, 39% skipped a medical test, treatment, or follow-up recommended by a doctor because of cost, and 35% did not fill a prescription for medicine due to cost, according to the report.

The burden of medical debt is significant, driving greater financial vulnerability across a broad range of measures. For example, adults with medical debt are more likely to be in households that spend more than their income, find it very difficult to pay their bills, have no “rainy day” fund, or have had substantial declines in income over the prior year. Further, those who have experienced medical debt are more likely to view their credit report as bad or very bad, to say that “just getting by” describes them, and to report that they rarely or never have any money left at the end of the month, according to KFF.

Better engagement and transparency, greater collections
While multi-factored societal problems such as growing medical debt require numerous approaches to solve, providers can play a role in easing this widespread problem. By adopting digital patient engagement tools that make it easier for patients to pay what they owe and by proactively offering the ability to pay over time in installments. Further, providers can deliver greater price transparency to patients to help them better understand what they owe and avoid unexpected costs.

For example:

Online pre-service check-in and cost estimates: Providers can help patients save time by offering online pre-service check-ins to confirm important information, such as demographics, insurance and benefits coverage, copay, and service amount estimate based on visit type and the patient’s individual health plan. Byinforming patients of likely out-of-pocket costs prior to appointments, providers can improve the likelihood of prompt collections. Further, with pre-service cost estimates, providers can collect copay and out-of-pocket costs at check-in, while at the same time storing patient credit card information to automatically bill for any balance due, all within existing workflows.

Post-visit payment plans: Patients experiencing medical debt can often benefit from receiving the option of using flexible payment plans. By proactively extending some payment flexibility to patients who are likely to need assistance, providers can increase collection rates and reduce the amount of bad debt sent to collections agencies. For example, providers can implement technology that can use propensity to pay scoring to identify patients who may need financial assistance to propose splitting up an invoice when the balance is first delivered. This offer provides a more palatable option for patients to pay bills when they cannot afford the entire payment. Integration with electronic health records systems prevents double-posting of charges and improves the patient experience through better price transparency in patient portals.

Health insurance helps make health care more affordable for some Americans, yet many still struggle with medical debt despite having coverage. In turn, unaffordable medical debt leads some patients to forego needed care, often leading to worse health outcomes. While providers can’t solve the medical debt problem themselves, they can offer patients some relief with digital engagement tools that deliver flexibility and convenience.

Ryne Natzke is the chief revenue officer of TrustCommerce, a Sphere company.

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© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health