People buy lots of products without truly understanding how they work. But unlike that automatic wine corker you impulse-bought from Brookstone last month, not every purchase comes with a 20-page instruction manual—or ends up working the way we imagined it would. For many consumers, that frustration definitely applies to the health insurance selection process. And that’s especially true for those who are new to the insurance market—for example, the millions of Americans who recently gained access to health coverage via the Affordable Care Act (ACA).

The PT Patient’s Guide to Understanding Insurance - Regular BannerThe PT Patient’s Guide to Understanding Insurance - Small Banner

Vexing Vocabulary

But that word—“coverage”—is a huge part of the reason why so many previously uninsured people have found the world of insurance so incredibly perplexing. After all, as those of us in the healthcare industry know all too well, just because an insurance carrier “covers” a particular service doesn’t mean it will pay the full cost of that service. And it certainly doesn’t mean the patient won’t have any financial responsibility. Holy counterintuitive, Batman.

Of course, the pervasive lack of insurance literacy that has plagued the post-ACA healthcare world should come as no surprise. According to pre-ACA research cited in this 2013 Forbes article, “just 14 percent of respondents had an understanding of the most basic insurance concepts of ‘deductible, copay, co-insurance and out-of-pocket maximum.’” And a study referenced in this 2014 Kaiser Health News story revealed that only “one in 10 people in the U.S. have a proficient level of health literacy.”  

Burgeoning Balances

Unfortunately, healthcare providers—including physical, occupational, and speech therapists—are often left to deal with the financial fallout of that confusion. In the years since the ACA went into effect, I’m betting you’ve experienced some version of the following chain of events:

  1. New patient calls to schedule appointment.
  2. Front office verifies the patient’s insurance benefits.
  3. Patient completes one or more visits at your clinic.
  4. Patient receives bill after his or her insurance processes the claim(s) for said visit(s).
  5. Patient becomes angry or upset/refuses to pay/never returns to your clinic.

There’s a good chance that in some cases, your practice—despite making a valiant effort to collect the balance due from the patient—has failed to recoup the amount owed. And that puts providers like you in a tough spot. After all, it is not your fault:

  1. that patients enroll in insurance plans without fully comprehending the terms of those plans;
  2. that those patients are often shocked to discover that the services they thought were “covered” aren’t actually covered—at least not to the degree that they assumed; and
  3. that some patients cannot—or will not—pay the high copays, coinsurances, or deductibles that they unknowingly agreed to cover when they purchased their plans.

And yet, here you are, struggling to keep your head above water as the pool of past-due balances gets deeper and deeper. Regardless of who is at fault, you—the provider—are the one who ultimately loses (well, you and the patient, who may end up forgoing the treatment he or she desperately needs). But, you can only do so much—right? After all, you don’t have the time—or even the expertise—to play insurance consultant for every one of your patients.

Still, you must do something. Hopefully, you’ve already implemented a comprehensive insurance verification protocol in your practice—one that allows you to provide cost estimates and collect patient payments upfront whenever possible. Major props if you or your front office staff already use that process as a springboard to have clarifying conversations with your patients. This is a great time to make sure patients understand which expenses they will be responsible for—and why. As the author of this Physicians Practice post points out, “It would be ideal if the insurance company took the time to explain plan details and teach patients how best to utilize their plan benefits. We know this will never happen, as it would be very costly for the insurance company.” So, the author continues, “Take it easy on your patients and find it in your heart to spend the necessary time with your patient; remember this likely someone's dad, mom, sister, or brother.”

Purchasing Power

If you’re pressed for time—and in a busy therapy practice, who isn’t?—consider supplementing some of those face-to-face conversations with educational resources patients can use to get themselves up to speed on the ins and outs of insurance. As PT office manager Asia Giuffrida explains in this blog post, “Education is key! Rather than simply explaining how much a single physical therapy visit is going to cost, it’s time for us to help our patients learn how to determine that information for themselves.” For that reason, Giuffrida created a patient-facing insurance guide for patients who had questions about their coverage. She hopes the guide will combat some of the sticker-shock that often keeps patients from starting—or returning to—therapy. “After all, there is nothing more discouraging than seeing my PT colleagues work so hard to help patients feel better, only to have those patients quit prematurely due to cost or confusion over their insurance benefits,” Giuffrida wrote.

In the interest of promoting greater insurance literacy across the entire rehab therapy patient community, Giuffrida even teamed up with WebPT to provide all of her therapy peers a customizable version of her guide (you can download it free here).

Download the PT Patient's Guide to Understanding Insurance

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While the ACA has brought much-needed insurance coverage to millions of Americans, it’s also had some unintended—though somewhat expected—consequences. And that has put a lot of financial pressure on healthcare providers—including rehab therapists. Have you noticed an influx in uninformed insurance beneficiaries in your practice? What have you done to reduce patient confusion—and avoid unpaid patient balances? Let us know in the comment section below.   

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