The reality that health care billing can cause confusion for patients is likely not surprising. While I work with executives in health care organizations across the country, I'm also a patient of the medical system, and I can identify and resonate with gaps between the provider and the insurer.
The data further validate that theory. In one 2024 survey that looked at the financial experience of patients, 56% noted feeling stressed when trying to understand what they owed. Of the same group, 28% delayed paying a bill because they were confused about what their benefits actually covered.
While billing for medical care is handled by third-party insurance providers, the stress, confusion, and frustration patients experience is directed at the system itself—the doctor's office, the hospital, or the outpatient facility where patients receive their care.
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Patient experience is a key metric for leaders of health care organizations. The correlation patients make between health care providers and insurance providers cannot be ignored as part of the overall success of the system.
Here are my top reasons why health care executives should prioritize streamlined billing services and positive after-care experiences for patients, as well as ways leaders can do just that.
Poor Billing Experiences Impact Patient Retention
As a result of a poor billing experience—whether a patient is unclear about what they owe, why they owe the amount billed to them, or how to pay a medical bill through their insurance provider—the health care provider is often the establishment that bears the brunt of that negativity.
The 2024 survey noted more than 95% of patients say coordination between the medical provider and the insurer in creating a positive billing experience is important in their decision to return to a provider and recommend it to others.
In addition, more than 40% have left negative reviews of providers due to a bad billing experience, and 38% have switched providers completely.
I understand the importance of patient retention as it relates to both patient care and the financial standing of the institution. Addressing patient dissatisfaction in this realm of health care can have a critical impact on the organization's bottom line.
A Lack of Coverage Understanding Can Harm Patient Health
Studies show nearly 50% of patients insured under Medicare Advantage plans lie to their doctors. While most lies told were to avoid embarrassment related to lifestyle habits, patients also weren't forthcoming about their adherence to medical treatments. This includes being able to afford the medications, tests, and follow-ups prescribed to them.
When patients aren't honest about their understanding of their coverage or their ability to pay for services, the outcomes aren't in the best interest of their health and well-being and can result in high readmission rates and increased costs for both the health care provider and the patient in the long run.
How Health Care Leaders Can Bridge the Gap
Despite health care and insurance being separate entities, there are opportunities for health care leaders to forge connections between the two groups for the betterment of the shared public they serve.
I recommend leaders start with the basics: Spearhead clear opportunities for patients to understand their coverage. From coordinating seminars, hosting recorded sessions, having accessible FAQs on the website and in patient portals, and more, providing ease of access to the information patients need is critical. Through tools like AI and surveys, leaders can get an understanding of what questions and hurdles patients experience most and address these issues first.
In addition to prioritizing opportunities for provider/payer collaboration, leaders can facilitate streamlined systems and processes to help patients find what they're looking for.
While the work doctors do is founded in science and math, at its core, to be a doctor is to care for people. Physicians, nurses, and medical personnel should be empowered to have financial conversations with patients and be aware of the assistance available to help patients get the medical treatments they need, when they need them.
From my perspective, it's important for health care leaders to work side by side with insurance providers to understand the pain points patients experience most. In doing so, they can bring positive change to how patients navigate the financial side of their medical care and perceive their medical experience overall.
Uncommon Knowledge
Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.
Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.
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