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Oh my, what do I owe?

As payor/provider contracting issues create more financial responsibility for consumers and self-insured employers, more risk is shifted to the people least able to make informed decisions, and least likely to consider the financial consequences of those decisions.

For example, consider the financial implications of simple contractual issues such as facility fees, or out-of-network providers such as ER doctors, anesthesiologists, or even radiologists. This New York Times article sheds light on this trend:

“As insurers ratchet down payments to physicians and hospitals, these providers are pushing back with a host of new charges: ophthalmologists are increasingly levying separate “refraction fees” to assess vision acuity. Orthopedic clinics impose fees to put an arm in a cast or provide a splint, in addition to the usual bill for the office visit. On maternity wards, new mothers pay for a lactation consultant. An emergency room charges an “activation fee” in addition to its facility charges. Psychologists who have agreed to an insurer’s negotiated rate for neuropsychological testing bill patients an additional $2,000 for an “administration charge.”

These are interesting challenges for providers. On the one hand, it’s perfectly reasonable for providers to recoup costs from consumers what they cannot secure from powerful payors at the negotiating table. On the other hand, these same consumers often fail to “appreciate” the provider’s circumstances and react with anger when faced with a financial burden resulting from their own healthcare choices. This puts healthcare providers between a rock and a hard place.

Ultimately, the evolving landscape calls for a new approach to communication – especially communicating value. Healthcare providers need to tell their stories, provide context, and bond with both consumers and employers like never before. They need to help consumers understand the true consequences of their choices, and make better choices as it relates to their care and the financial consequences of those choices. These are complex times, and we must help improve both healthcare literacy and health insurance literacy. Both are important, and both have huge consequences for the long-term financial health of provider organizations.

February 8, 2018
Providers must prepare for payor negotiations in 2019 and beyond.
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