In health care circles, the topic of patient responsibility can be a pretty touchy subject.

Patients who fail to pay their health care bills tend to be characterized as one of two things: downtrodden, usually reserved for those who are financially unable to pay their bill, or as delinquent, otherwise known as irresponsible consumers who are unwilling to pay.

Unfortunately, payment responsibility is more complex than either label. The growth of high-deductible health plans has forced greater financial responsibility onto the consumer without the associated cost transparency – an issue that is challenging to patients and providers alike. Add to that a mix of confusion about plan designs and an expectation for consumers to adopt new financial behaviors, and you end up with a scenario like the following:

Recently, a customer who works in a medical office told me the story of how she let a $26.32 physician bill go to collections. She was a member of a high-deductible health plan, and most of her family’s medical bills were automatically paid by the plan or from their health care reimbursement account. Towards the end of the year, when funds were depleted, they started to get bills in the mail.

She could have paid the balance at the time of service, but the physician’s office couldn’t tell her what she owed when she was there. So when the bill showed up in the mail, she set it aside with the intent to add the physician to her online banking system to pay. Thirty days later, she received another bill, reminding her that she hadn’t yet paid it. Then it happened again 30 days later. Before she knew it, the bill went to collections.

It wasn’t that she didn’t want to pay it or couldn’t afford to – it was simply inconvenient. It finally got paid, but who won in that? No one. She ended up with a negative mark on her credit and the doctor’s office likely spent more money collecting than was actually owed. The system failed.

Harassing patients about their financial responsibility doesn’t solve the problem we have in this new reimbursement landscape. What the health care system needs most is the ability to tell the patient —with a definitive level of accuracy akin to all other consumer interactions – what they owe at the point of service so the provider can collect payment accordingly before the patient walks out the door. Technology exists today to adjudicate claims in real-time, but processes are further behind.

The secret to collecting patient payments is to redefine patient flow processes to be synchronized with the health information technology tools and solutions available to:

Check patient eligibility and benefits

Pre-adjudicate a claim for estimated patient responsibility costs

Adjudicate a claim in real-time to get final patient responsibility amounts

Collect and process all forms of patient payments, and

Establish patient payment plans for larger amounts

Increased patient responsibility isn’t a new problem, but it is a growing problem without a standard solution. Availity has a number of key solutions that fit within the workflow described above. Please contact your customer account manager for more information.