Patients Need to be Educated on Health Care Benefits

A recent survey found that 55% of consumers are spending more than $1000 out-of-pocket on health care services, and are not satisfied with their health plan benefits.

Health care costs are rising, and more financial burden is being placed onto individuals than ever before. Some individuals may also be questioning if they should sign up for health insurance through the Affordable Care Act.

Since the exit of multiple small and large insurers, consumers have faced higher premiums and less choices. CMS even implemented new strategies to increase enrollment for 2017.

Despite these extra efforts, the Copatient 2016 Healthcare Financial Management Survey found that 25% of consumers did not even know when open enrollment for 2017 began. Included in the survey were 515 consumers who reported that they were surprised by health care costs within the past year.

The investigators also found that more consumers are reporting spending more than $1000 out-of-pocket in the last year, and 15% of those respondents spent more than $5000 out-of-pocket. Additionally, 39% of consumers reported that they only somewhat understood their benefits, while 20% were unaware of what health plan they had.

“The financial model for healthcare is in the midst of a significant shift, which will require consumers to continue to pay for more of their healthcare out-of-pocket,” said Thomas Torre, CEO of Copatient. “Our survey findings underscore just how important it is that consumers engage in healthcare decision-making and take control of their financial choices and obligations, moving forward. It is also incumbent upon employers to help their workforce navigate medical expenses and understand their health benefits and options.”

Investigators also found that medical billing was caused great confusion for a majority of consumers. Approximately 66% of consumers reported that they received a bill they were unable to understand, according to the survey.

However, less than 1 of 3 consumers attempted to contact their provider with a question regarding the bill, while a majority reported they would take the matter up with the health insurer.

Some companies have created online tools where individuals can submit their medical bills for review to prevent any errors that may be present. The goal of these transparency tools is to prevent patients from overpaying hospitals and health care providers for medical bill errors.

Additional education and more online tools will be essential to the financial well-being of consumers as high-deductible plans become more prevalent, according to the survey.

These high-deductible plans also tend to have narrow networks, and can force patients to seek care from out-of-network providers. Some patients may experience care from an in-network and out-of-network provider at the same hospital. Over the past year, 30% of consumers reported that they were referred to an out-of-network provider, which was not covered by their insurance.

A top concern for respondents was total cost of a health plan, and this aspect outweighed the importance of quality of care. Interestingly, nearly 50% of respondents said that they do not shop around for lower cost procedures prior to receiving the treatment. Respondents indicated that they feel they do not have control over their health plan options, and that their employers have more control, according to the survey.

This feeling of lacking control is likely due to insufficient education, understanding, and resources provided to the consumers. Approximately 78% of consumers reported that they would utilize an employer-offered benefit that managed medical bills and controlled costs. Investigators at Copatient suggest using transparency tools, and shopping around before receiving care or purchasing prescription drugs. They also suggest that patients start taking advantage of all of their health care benefits to ensure they are making the most of their plans.

“These survey findings highlight the growing need to empower consumers around healthcare finance management. The confusion is evident, as is the desire for help,” Torre concluded. “At Copatient, we are working closely with consumers and employers to give people the tools they need to take control over their medical costs and make paying for health care easy.”