One of the most frustrating things for consumers of healthcare is the surprise medical bill. This is generally a bill that takes months to process before the consumer sees it.
Moreover, there remains a lack of cost transparency throughout the healthcare system, leaving consumers in the dark. By the time the healthcare consumer receives that surprise bill, he or she has forgotten the details of the service and thinks all bills have been resolved, making the cost an unexpected burden.
The root of the problem
As an industry, we need to accept the reality that the surprise medical bill issue is complicated by the fact that an entity that someone may go to for medical care doesn’t supply all bills to the consumer.
Hospitals have multiple departments, physician groups, and other entities that complete their own insurance claims and billing processes outside of the hospital. But this is much broader than a hospital system on its own island trying to solve the problem. The fact that bills can be generated from multiple locations makes the healthcare billing process more of an ecosystem than a single entity.
Regardless, there is no current widely available solution to this problem, even with the use of transparency tools and the like. Someone must take up the cause of communicating with the consumer truthfully and in a timely manner. We must also consider how traditional employer insurance holders get billed, how the payer or insurer level handles claims, and how those people not utilizing traditional insurance can be helped.
A proposed solution
A possible solution could be to create, as an industry, a billing mechanism that the consumer is familiar with: a credit card-like experience where billings are brought together in one statement, and consumers can easily understand how and why they owe money.
This also allows healthcare providers who are independent from one another, the option of singular, aggregated billing to consumers. This gives consumers the ability to see which entities have provided services, how those claims have been processed through insurance, and the total amount owed for all services in a single billing statement.
Health Payment Systems (HPS) has provided an example of this concept within the Wisconsin provider network that we have created. We pay patient claims directly to the provider, aggregate all monthly medical charges for an individual or family in a simple bill, and provide easy payment options for the consumer. Average hospitals collect 50-60% of what they are owed; we collect over 85%. That extra 30% translates into millions of dollars over the course of a year.
Next steps for the healthcare community
It is essential that the healthcare community creates an engaging and user-friendly way to create aggregate bills for consumers to eliminate the surprise medical bill phenomenon. The industry needs teams who can
advocate for the consumers while working to increase the percentage of bills getting paid.
HPS is a Milwaukee-based health care technology and services organization offering solutions to enhance the consumer billing and payments experience, while driving value to health care providers, health insurance companies and employers. HPS’ patented solutions include its comprehensive independent provider network in Wisconsin and a single consolidated statement of medical services for patients.