Managing Consumer Out-of-Pocket Costs

— By Matt Zabolotny
Blog Post
Managing Consumer Out-of-Pocket Costs

As a Human Services provider, it is becoming increasingly challenging to manage consumer payment responsibilities from commercial insurances. Provisions under the Affordable Care Act are increasing the amount of money consumers must pay, and as a result commercial insurances are placing more financial responsibility on their members: your clients. It is essential to develop policies to communicate these expected costs to your consumers while prioritizing the financial health of your organization.

Consumers walk through your doors and present a wide variety of commercial insurances, each with unique benefits, copayments and deductibles to consider. Because of these complexities, your team needs to be prepared to effectively manage and communicate the financial responsibilities that fall to each client. Developing and consistently implementing a consumer-driven payment policy helps create a trusted relationship with your clients – a must for behavioral health organizations in a value-based care setting.

It is important to consider all outcomes when developing a consumer-centric policy, including a denial of service if an individual cannot cover their financial responsibilities. Working in conjunction with your care teams on policy formation ensures the best interest of the individual is at the forefront. Your business depends on how effectively you manage consumer payment responsibility as well as how consistently a policy is implemented. If you’re looking for a place to start, here are a few key tips:

  1. Develop Your Plan – Before you implement changes, you must develop a policy that fits the needs of your organization and the individuals you serve. Engage your clinical team in developing policies so everyone involved in consumer care contributes to, and understands, the new consumer-driven plan. When a question arises from a client, your team member can refer to your established policy to provide consistent answers and plan of action without question or hesitation.
  2. Train Your Team – Once a policy is developed, train your staff, particularly your team members working the front desk, on how to have effective payment conversations with consumers. This can be a difficult conversation and can take practice for your team to become confident and clear in their communication. Arm them with talking points, resources, and leadership support so they can effectively engage with your consumers and are able to collect payments at time of service with ease.
  3. Review Coverages – As mentioned, your clients will present a wide variety of commercial insurances. Behavioral health organizations need to mirror the practices implemented by many physician offices. Learn the individual’s current insurance status beyond “active” or “inactive.” Understanding their deductible, what services are covered, copays, effective dates, and if authorizations are required will prepare you for providing excellent customer service to your consumers. You will be able to answer questions, advise them on potential out-of-pocket costs, develop a payment plan, and give them peace of mind as you prepare them to receive care from your organization.
  4. Communicate, Communicate, Communicate – It is vital to communicate the financial policy to your consumers. You cannot overcommunicate this. Every current or future client should understand your financial policy to avoid potential confusion or frustration. Effective ways to notify clients include email, direct mail, posting policies on your website, placing signage at the front desk, and discussing it during the check-in process. Communicate your policy and stick with it. In the long run, your clients will appreciate your consistency and know what to expect when they arrive.
  5. Seek Outside Expertise – If you are not sure where to start or have questions on what will work best for your organization, ask for help! As a business, you can’t afford to continue with a financial policy that results in frustration from consumers and does not yield an increase in cash flow. An experienced, outside perspective can find gaps in current protocols and uncover where additional support is needed, allowing you to provide better client care and gain financial stability.

Zmark Health offers a variety of revenue management services and will give you the tools to manage the changing landscape of commercial healthcare insurances. Adapting to these shifting reimbursement models and updating your policies will allow you to keep pace with changes in the behavioral healthcare industry. Your expertise will give you a reputation as a knowledgeable, supportive organization providing top-rated customer service.

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