Helping Patients Understand Their Health Insurance Coverage

by Applied Medical Systems

Just like people, healthcare insurance plans come in a variety of shapes and sizes. Even when working with the same insurance company, plans can vary drastically. And let's be honest, understanding insurance terminology is almost like learning a new language. Terms such as PPO, HSA, and HMO are foreign to most average Americans. That is why at times your patients may have difficulty understanding their coverage. That is where you come in.

Explaining Benefits Could Avoid Negative Interactions

As a healthcare provider, it is important to help your patients understand their health insurance coverage and benefits. Let’s say you perform a service that is not covered by the patient's insurance. Most likely your patient assumes that their insurance will pay for the service. However, your patient receives an EOB in the mail and about faints. The patient now owes you out of pocket for the service that they assumed as covered by their insurance. This scenario most likely ends with a string of upset phone calls and maybe even a lost patient and negative review. To avoid scenarios such as the one above, healthcare providers should help their patients understand their health insurance coverage prior to performing a service. For example, an OB/GYN office may have a representative from the billing department meet with expectant parents on their first visit to go over the costs associated with having a baby, review the patient's insurance plan, and discuss payment options.

3 Questions You Should Be Prepared to Answer

Today, with more people insured than ever before, and some for the first time in their lives, there are many questions to be answered. To best serve your patients, help them answer the following 3 questions:
  1. What does my plan cover?
  2. What is my deductible and why do I have to pay it?
  3. What is my copay and why do I have to pay it?
As a healthcare provider, terms like copay and deductibles are a part of your language, but keep in mind these terms are foreign to many of your patients. Provide resources to your patients, such as a glossary of common insurance terms or a link to the health insurance exchange were plan information is found. The more you can educate your patients on their coverage, the more likely they will be to take advantage of their plan.

Learn More About Applied Medical Systems

As a medical billing company, Applied Medical Systems (AMS), strives to keep healthcare providers and their patients satisfied. That is why we find it important to help patients understand their insurance coverage. When you work with AMS, your patients will always speak with a U.S. based billing specialist when they have questions or concerns regarding their account. Learn more about the services provided by AMS, including our medical billing, coding, and practice management solutions. Request a free quote today.