You were likely already looking for ways to improve your business model’s member transparency before now. But when HHS announced the No Surprises Act framework earlier this year, you really had to take a closer look at your billing platform. These latest government initiatives seek to provide relief to members from surprise billing and exorbitant healthcare-related invoices. So if member transparency is still on your radar of improvements to make, keep reading. Here are three ways to significantly adjust your strategy.
1. Adapting to the ‘No Surprises Act’
If you haven’t already, you’ll want to start by adhering to the requirements outlined by the “Requirements Related to Surprise Billing,” aka the No Surprises Act. Then, analyze and rework each of these areas within your plan model to ensure compliance and ultimately improve member transparency in billing. Here are a few of the specific bans outlined by the latest policy announcement. All bans are slated to take effect on Jan. 1, 2022.
Bans on Surprise Billing
Emergency services can be expensive to pay for, especially if a patient seeks care, unintentionally outside of his or her insured network. So this new ban provision says regardless of where a consumer seeks treatment, billing has to reflect in-network pricing. Unless prior authorization exists, these ER visits can no longer be surprisingly expensive.
Bans on Surprise Out-of-Network Costs
While similar to the ban on non-network cost-sharing, this ban language speaks directly to both healthcare providers and insurers, requiring plan term definitions of pricing and consistent notification of impending costs. In addition, patient consent is required for any out-of-network treatments to make sure the patient doesn’t face surprise expenses after the fact.
Bans on High Out-of-Network Cost Sharing
As part of the No Surprises Act, coinsurance, deductibles, and additional cost-sharing stipulations can’t be higher than in-network provider pricing. And this ban applies to both non-emergency and emergency health services. This ban is designed to level the playing field and avoid those instances of surprise billing that members can’t ultimately afford.
2. More Robust Communication
One of the easiest and probably more effective ways to improve operational transparency in any business model is by creating a more robust communication strategy. In the health insurance industry, how, what, and when you communicate with your members is mission critical. Improving your process for engaging members can be huge for member transparency.
In-Network vs. Out-of-Network Notifications
Part of your provider communication platform should include notification of in-network and out-of-network provider services. Some research suggests that a staggering one out of every six visits to the emergency room involves some form of care from at least one out-of-network health network provider.
Emergency room transport has astounding costs as well, according to a study by the Government Accountability Office in 2019. The average cost of air transport alone rose from $36,400 to $40,000, with more than 70 percent representing out-of-network providers. When members use these ER services, they might not realize the out-of-pocket costs that result from these out-of-network provider services.
Having a notification on the insurer’s end would help alleviate some of these surprise instances.
Requiring Additional Permissions Prior to Billing
Another method of improving member transparency through communication is with the implementation of permission requirements prior to billing. In other words, laying in extra steps to verify in and out-of-network providers before the member moves forward will allow you to then communicate any potential costs associated with the service. Members then can see for themselves and make the decisions they need to for their health and budget accordingly.
Communicating Cost Reminders
The best way to ruin the surprise party is by telling the guest of honor there’s a party. So it makes sense that sometimes enacting basic communication reminders and notifications about upcoming costs, impending costs, and additional expenses for those out-of-network providers can be just the line of defense you need to combat the transparency in health insurance concerns. So make sure you’re levering the many reminder opportunities you have to help remove any veil of uncertainty.
3. Transparency in Pricing
CNBC reported previously that nearly two-thirds of all bankruptcies filed in the U.S. involved super-lofty medical expenses. Healthcare costs matter to your members. And when so many of these invoices come as a surprise, it presents insurance providers an opportunity for transparency. Shine a light on every aspect of billing to educate, remind, and prepare your members for the invoice amounts.
Create Easy-to-Find Pricing Definitions
Half the battle when it comes to really understanding healthcare billing procedures and pricing is understanding the definitions of services, terms, and coverage. To improve member transparency, you can look for new ways to offer and remind members about the terms of their coverage. Avoid using industry jargon when possible and be clear about explaining coinsurance, copays, and out-of-pocket costs.
Be Prepared to Address Member Questions
Every member you engage will have a unique profile and healthcare situation. These differentiating circumstances will sometimes require a more customized approach to customer service and communication. This means that while FAQ sections and transparency efforts help, it’s still best to also have a layer of customer service available to answer specific questions at the member level. Be available to offer clarity in each individual situation to ensure members have a complete understanding of how to proceed with managing their health and healthcare costs.
Partner with W3LL to Help
Some sources suggest that a vast majority of Americans still have some level of distrust of insurance providers. This widespread distrust leads to member churn and reduces overall engagement. Health plans should look for innovations in technology, like Enhanced Direct Enrollment, to bridge those gaps and rebuild loyalty and trust. Members will trust what they consider to be transparent, especially when it comes to pricing. W3LL can help with these efforts in both identifying software breakdowns and available solutions.
When you’re ready to make necessary adjustments to improve member engagement, let W3LL help! Whether your platform is changing because of the “No Surprises Act” or seeking enhancements in general, now is the perfect time, with Open Enrollment in effect, to enact new transparency strategies.[table id=23 /]