Consumers Blame Healthcare Providers And Insurers For Bad Financial Experiences, New Study Shows

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As evidence suggests consumer expectations in healthcare are rising, healthcare providers are rushing to offer online services and digital communication options. But new data released today suggests one area providers and insurers should be paying more attention to is billing and finance to please consumers.

According to 2021 Healthcare Consumer Experience Study From Cedar, a health care financial platform, many consumers are dissatisfied with their financial interactions with both healthcare providers and health insurers.

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“As the health industry continues to transform for the digital age, it is increasingly clear that consumers’ billing demands need to take center stage,” said Cedar CEO and cofounder Florian Otto.

In a survey of more than 1,500 consumers, all of whom had paid a medical bill in the past 12 months, 40% of respondents said they were not satisfied with their providers’ billing practices and 39% reported dissatisfied with the conversation they had with them. reported to be. their health insurer about medical bills.

Specifically, 37% of respondents said they are not satisfied with the clarity of billing and payment communications from their provider. Similarly, 36% said they were dissatisfied with the clarity of their health insurer’s explanation of benefits (EOB) and 34% said those communications were not timely enough. A third (34%) also reported dissatisfaction due to mismatch between provider bills and the insurer’s EOB.

To make matters worse, consumers often have to bridge the gap between their healthcare providers and their insurer. Perhaps not surprisingly, nearly a third (31%) of consumers reported being dissatisfied with the coordination (or lack thereof) between their providers and insurer.

“This lack of alignment, combined with the fragmented nature of health care, leaves consumers feeling helpless at times,” Otto said. “Consumers are not only struggling for more explanation and less surprises from their financial experience, they’re also yearning for collaboration.”

This lack of cooperation can have consequences for both providers and payers.

The vast majority (93%) of consumers said that the quality of their financial experience with a provider was a significant factor in their likelihood of returning to that provider and 57% said they were more likely to recommend a provider who Provides a great digital experience. , Nearly all (96%) said the quality of their financial experience affected their satisfaction with their health insurer.

Thirty-five percent of respondents said they have switched or will switch healthcare providers for a better digital experience for administrative interactions with their provider and a third have switched or changed insurance to achieve a better digital member experience Is.

Consumers seek reform from both insurers and providers.

Nearly half (45%) said they would like to see more clarity about what services are authorized by their insurance company and 42% said they would like better transparency about out-of-pocket costs. One-quarter said they want better ways to get their questions answered faster and a third want to better understand what to give and why.

Nearly all consumers (90%) said they would appreciate it if their providers posted pricing or expected out-of-pocket costs online, but only one in three said their providers do so consistently. Of the 58% who tried to find out-of-pocket cost information before seeking care, 40% said it was difficult to find.

Specific improvements consumers want include the ability to pay their bills or communicate with their providers (64%), online payment options for medical bills (56%) and health insurance premiums (25%), enhanced pre-authorization procedures. Includes completion capability. Online (32%), and an easy way to resolve payment issues with your insurer online.

The link between provider bills and insurance information emerged as another point of frustration. About two-thirds (65%) of people said they wish they could see information on their benefits along with their medical bills.

Poor financial experience and cost confusion create a mental toll for consumers. More than half reported feeling stressed about paying medical bills (55%), understanding their health insurance coverage and benefits (53%), and resolving a billing problem with their insurer (59%).

The illusion is more than stressful; According to Kim Bucky, vice president of customer services, this could cost consumers money. directpath, a profit advocacy and education firm.

“Consumers are paying more for their care both on the front – when they receive services – and after the fact – because they don’t review and question their EOBs and bills,” Bucky said. “Depending on which report you read, somewhere between 60% and 90% of medical bills have errors—and these errors are almost never on the consumer side.”

According to a Cedar survey, confusion also makes consumers less likely to pay the bill. More than a third (37%) said they would not pay a health care bill if they did not understand the administrative process or experience.

But ignoring bills can lead to dire financial results.

a JAMA Studies Published earlier this year, it shows that about 18% of Americans have medical debt, totaling about $140 billion, although some estimates are even higher.

In Cedar’s survey, 19% of respondents had gone into medical debt collection. Nearly half (48%) of them said they could not pay the bill. But about a third (32%) attributed the shortfall in collections to incorrect bills and 28% said they did not understand the bill.

According to Bucky, the lack of health insurance literacy among consumers is at least partly to blame. Many consumers do not understand the language or concepts of health coverage, making EOBs or bills difficult to read and understand.

“If you don’t know what to look for — or you don’t know how to ask for a specific bill from your provider — you may not realize that you’ve been charged hundreds or thousands of dollars,” Bucky said.

Bucky encourages consumers to ask for detailed billing details from the provider broken down by day and service. And, she says, never pay a medical bill until you’ve found your health insurance EOB and you’ve had a chance to spot discrepancies.

“If something seems strange – question it,” she said. “Mistakes happen.”

Bucky often says, a simple phone call to the billing department can solve the problem. If not, say so.

“Remember,” Bucky said, “you have the right to ask for corrections or even file a complaint if you are unhappy with the services you receive.”

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