Expectation vs. Reality: Improving the Patient Payment Experience

If you’ve ever worked behind the scenes at a provider organization, you likely gained a deep understanding of what makes medical practices tick, giving you the ability to make fairly accurate assumptions about how patients will probably behave in different scenarios. However, when it comes to the patient payment experience, inevitably some patients respond differently than expected.

Seasoned healthcare workers have likely experienced a number of common misconceptions about patients’ behaviors, demands, and preferences. While many providers and staff may already be aware of these misconceptions, the broader healthcare community may not be as familiar. Here are a few scenarios where provider expectations sometimes fail to align with reality. T

EXPECTATION: Patients have a thorough understanding of their own medical coverage.

REALITY: Common health insurance terms such as “in-network,” “deductible,” and “copay” are used so frequently in medical practices that they are recognized and understood immediately by staff. However, for many patients – particularly those who only interact with the medical system a few times per year – these phrases and concepts are much less familiar. Acronyms like EOB and EHR only add to potential confusion. 

For example, one consumer survey asked insured adults about how well they understand key aspects of their health insurance – what it covers, what they will owe out of pocket when they use care, how to find information about provider networks, what their explanation of benefits (EOB) statements say, and common terms used in health insurance. 

The survey found that 51% of insured adults say they find at least one aspect of how their insurance works at least somewhat difficult to understand. Further, education level did not appear to help as 58% of college graduates said they had difficulty understanding an aspect of their insurance coverage.

EXPECTATION: Patients expect lengthy appointments and a time-consuming in-office experience.

REALITY: Patients today are pressed for time and expect the convenience from healthcare that they’ve experienced in other consumer interactions. They are less tolerant of delays that some providers may view as a routine part of doing business.  However, by embracing new technologies such as self-service online check-in, providers can reduce manual paperwork and improve the patient experience.

EXPECTATION: Patients comprehend their financial responsibility.

REALITY: When it comes to understanding their out-of-pocket costs for medical bills, patients are often left in the dark until insurance documents arrive in the email. For example, one survey found that only 52% of patients fully understood their financial responsibility for a recent medical bill. The same survey revealed that 60% of patients surveyed said they are at least somewhat likely to pay their bill upfront if a cost estimate is offered in advance or at the time of service. To help patients improve healthcare literacy while also boosting patients’ engagement in their own care, providers can educate patients on their coverage and what it means, whether via online resources, in-office signage, or a one-on-one conversation at the time of service.

Additionally, because patients are more likely to pay when they know upfront costs, delivering accurate up-front estimates is a best practice for providers. Cost estimation tools can create clear projections that enable patients to know what will be owed at or before the time of service. After clarifying responsibility with patients, it becomes easier to facilitate payment and gain a card-on-file prior to the patient leaving the office. Additionally, the transparency and predictability provided by accurate upfront estimates can improve patient trust and loyalty.

EXPECTATION: Patients adequately budget for medical expenses.

REALITY: Four in 10 U.S. adults have some form of healthcare debt, according to a Kaiser Family Foundation survey. Uninsured adults, women, Black and Hispanic adults, parents, and those with lower incomes are especially likely to say they have healthcare-related debt.

Further, about half of adults – including three in 10 of those who do not currently have health care debt – are vulnerable to falling into debt, saying they would be unable to pay a $500 unexpected medical bill without borrowing money. Of course, the ability to pay varies by patient, but medical bills sometimes go unpaid due to other more immediate needs. 

EXPECTATION: Older patients prefer traditional payment methods.

REALITY: While conventional wisdom holds that young people are more likely to use digital technology than seniors, that doesn’t mean that older patients don’t take advantage of more modern convenient options. For example, a PYMTS survey recently found that 8% of Baby Boomers and seniors had made a payment through a physicians’ website, which matched the percentage of Generation Z. Similarly, more than 20% of seniors and Baby Boomers reported making a payment through a patient portal. Clearly, digital payment options are not just for the young. 

Reality doesn’t always conform to our expectations, and the reality of patients’ healthcare payment habits is no different. By understanding healthcare payments through the eyes of patients, providers can take steps to improve the payment experience. 

About Ryne Natzke

As Chief Revenue Officer of TrustCommerce, Ryne Natzke is responsible for managing the integrated health and payments strategy and largest, strategic accounts across our key verticals, including both large merchants and software partners. Previously, he worked with early-stage digital health companies at HealthX Ventures and managed partnerships at Epic.

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