A Short Guide to Avoiding Unwelcome Surprises

Many news headlines today boil down to one issue. Trust.

 Or rather, the growing lack of trust. For reasons that are too complex to address here, our country is experiencing a breakdown of trust in its governmental, religious, and educational institutions, among others. Healthcare organizations have not been exempt from this societywide trend. 

A low level of price transparency exacerbates trust issues in health care. Many consumers find it difficult to get a price estimate before receiving care, leading to avoidable anxiety about their out-of-pocket expenses. Receiving a surprise out-of-network medical bill is the wild card in an insured consumer’s healthcare budget, because such bills can be unpredictably high, insurance coverage is low by design, and recourse is limited. A typical surprise-bill scenario is a patient who chooses an in-network hospital for a procedure but receives services from an out-of-network provider, such as a pathologist, radiologist, or anesthesiologist. Among consumers with large employer coverage, nearly one in five inpatient admissions includes a claim from an out-of-network provider, according to a recent study by the Kaiser Family Foundation. 

It’s easy to see why consumers don’t like surprise bills and why they garner so much media attention. From a provider’s perspective, surprise bills undermine efforts to build or restore trust and patient loyalty.

Although the issue is not new, state legislative efforts to mitigate it have ramped up in recent years, as media attention has increased. In September, a bipartisan group released draft federal legislation designed to protect patients in both insured and self-insured plans from surprise out-of-network bills. (Current state laws don’t apply to consumers who are covered by self-insured health plans.) It’s too soon to know whether this bill will advance.

Back in 2014 when our consensus report on price transparency was published—before the current wave of legislative activity—HFMA flagged surprise bills as an area that needed more attention. In a network-based healthcare system, ideally, any out-of-network bills would be intentional— i.e., incurred by patients seeking out-of-network care who are fully informed about the additional out-of-pocket costs. We’re definitely not there yet. There is no silver bullet for surprise bills. But there is an opportunity to educate consumers about how to reduce the risk of receiving them, and HFMA has acted on that opportunity. As we did with our original consumer guide to understanding healthcare prices, we collaborated with the American Hospital Association and America’s Health Insurance Plans to develop an easy-to-understand resource that shows consumers what they can to reduce the risk of receiving a surprise bill, step by step. The American Medical Association also provided input to the guide.

If you are with a consumer-facing healthcare organization, we encourage you to incorporate this guide in your pre-procedure communications with patients, and to download it and post it on your organization’s website. By doing so, you demonstrate your organization’s commitment to improving price transparency, educating consumers, and improving the patient financial experience. Most important, you will help restore trust—a priceless commodity—to everyday financial interactions in health care. 

Follow Joe Fifer on Twitter: @HFMAFifer