The ease and convenience of on-demand urgent care is a huge benefit for modern Americans. But too often, patients can receive excellent care only to need clarification on how much it costs at checkout. According to a GoodRx survey completed in 2022, 35% of participants chose a high-deductible health plan (HDHP). While these plans make participants eligible for a health savings plan, they can lead to sticker shock at the checkout counter.
So how does your staff help patients surprised by their urgent care costs? It takes a little education, a healthy dose of goodwill, and customer service. Arming every person on your patient-facing support staff, not just in the billing department, can ensure the visit is positive from start to finish. Here are three common scenarios for patient questions and how to answer them clearly and kindly.
Scenario 1: The patient still needs to meet their annual deductible, so they will owe the full contracted rate today.
So many patients are unclear about how much their annual deductible is–with HDHPs, deductibles can start at $1500 for individuals and $3000 for families. The first step is to calmly educate them on their deductible amount, how much they have met, and the practice’s contracted rate. Once that’s clear, you can move on to the payment method.
Example: “Let’s go over your urgent care benefits today. You have a high deductible health plan with a $5000 deductible, of which you have met $250 so far. Our contracted rate with United Healthcare is $150, so that is the amount you will owe today. Would you like to pay with a credit card, debit card, HSA, or FSA?”
Scenario 2: The patient met their deductible last year and didn’t pay anything at the time of care. In the new year, they are surprised to be charged.
Although everyone in the medical field is very aware of plan years, many patients are not. If you have a patient that is shocked that there will be a charge, gently remind them of the effective date of their current plan and when they had their last visit.
Once you’ve established the timeline, inform them of their current deductible and the clinic’s contracted rate with their insurance company. This is a great time to pause for questions. An understanding ear can mean the difference between a disgruntled patient and one that feels heard and understood, even as they have to pay unexpectedly.
Example: “Let’s go over your urgent care benefits together. You have a high-deductible health plan with a $5000 deductible and an effective date of 1/1/2023. You haven’t received medical care in 2023, so you have $0 towards your deductible this calendar year. Since you had your baby last year and met your deductible, you didn’t owe anything for your December appointment. In 2023, you will owe the contracted amount of $150 until your deductible has been met. Do you have any questions? Would you like to pay with a credit card, debit card, HSA, or FSA?”
Scenario 3: The patient has met their deductible but not their out-of-pocket maximum, so they owe a co-insurance of 20% of the contracted rate.
Since HDHPs have such high deductibles, it can be easy for patients to forget that the deductible is just the starting point of their coverage. For many patients, co-insurance applies during the gap between deductible and out-of-pocket maximum, which can be up to $7500 for individuals and $15000 for families.
Reminding your patient of their progress toward deductible and OOP max can be a helpful tool for their visualization of charges. Reminding patients they are only paying a percentage of the contracted rate might help soften the bill.
Example: Let’s go over your urgent care benefits today. You have a high-deductible health plan with a $5000 deductible, which you have already met. It looks like you are currently at $6000 toward your $8000 out-of-pocket maximum. Urgent care services have a 20% coinsurance applied toward your out-of-pocket maximum according to your plan benefits. Our contracted rate with United Healthcare is $150, so at 20% of $150, your amount owed today will be $30. Would you like to pay with a credit card, debit card, HSA, or FSA?”
In all of these scenarios, offering friendly, personable customer service and clear-cut information can help your patients leave feeling that they understand their benefits and what they just paid. A bonus? You may save them an extra call to their insurance company or your billing department. Arming all of your front desk staff with this information short circuits the normal hoops, saving time for your team and, most importantly, for your patients.
For even more simplified billing, Solv offers in-app billing where patients can pay with a stored card. We’d love to help you streamline your front desk experience–let’s chat about your options.
