FEATURE


seem to understand set copays for doctors’ appointments and


pre-


scriptions but quickly get confused when deductibles and coinsurance become involved.” To help patients understand their


Help Patients Better Understand Their Expenses


Educate up-front and be transparent about the bills they will receive BY ROBERT KURTZ


T


he data is in and it shows Amer- icans struggling to understand their health coverage. A 2019 Poli- cygenius survey of 1,500 consum- ers found that fewer than a third of respondents could correctly define copay, deductible and premium, and more than one in four said uncer- tainty over coverage led them to avoid treatment. “There are so many different con- cepts, and every insurance policy is different,” says Terri Mahoney, CASC, administrator of Bluffton Okatie Surgery Center in Okatie, South Carolina. “Many people work- ing in the medical field do not fully grasp health coverage. We should not be surprised that most patients strug- gle as well.” When patients do not understand their financial responsibilities, it can create multiple challenges for ASCs,


says Jeffra Kinniard, RN, director of operations for Parkview Surgery- ONE in Fort Wayne, Indiana. These include delayed and canceled proce- dures, lost revenue and dissatisfied patients. “If patients are surprised by their bill and find they cannot afford their out-of-pocket expense, it will be alarming to them financially and emotionally,” Kinniard says. “This can turn a very positive surgical out- come into a negative one.”


Knowledge Is Power To overcome these obstacles, ASCs should prioritize educating patients about their insurance and what it does and does not cover, says Alli- son Stock, RN, CASC, executive director of Great Lakes Surgical Cen- ter in Southfield, Michigan. “Most patients do not use their health ben- efits outside of routine care. Patients


expenses, Stock says her ASC’s sur- geons are encouraged to share the center’s polices, including those con- cerning financial responsibility, with patients when scheduling procedures. About one to two weeks prior to a pro- cedure, a member of the Great Lakes Surgical Center staff reaches out to the patient to review their health plan and go over its benefits. “We have our staff read to patients from a script,” Stock says. “We clearly explain all the providers that patients may receive bills from. We then remind our patients of their financial responsibility. When we reach out to give patients their pro- cedure arrival time, we answer any additional questions.” Parkview SurgeryONE takes a sim- ilar approach. The facility provides every patient with written information about their rights and responsibili- ties at the time of surgical schedul- ing, including details about the facil- ity fee, surgeon fee, anesthesia fee, and lab and other ancillary fees. The ASC also checks with its patients’ insurance carriers to ensure current coverage and determine whether pre- certification is required as part of the scheduling process. Kinniard says her ASC’s patients


are benefiting from a new initiative. Parkview SurgeryONE is jointly owned by a health system and ortho- pedic group.


The health system


recently opened a financial clearance department. One of the responsibili- ties of this department is to determine how much patients are likely to owe for their care. In a trial conducted in 2019, department representatives reached out to a limited number of the ASC’s patients to discuss deductibles


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