This week, Blake Walker and Jeff Hillam continue their discussion on deductible resets, sharing how clinicians can help prepare patients to have out-of-pocket costs at the turn of the year.

Jeff Hillam: The truth is that most patients don’t even understand their own insurance, and most doctors and the front desk don’t understand all the plans either, because you can’t know all the plans. It’s a complex world out there—a patient walks in and doesn’t know how their plan works, what deductibles are, or what their copay is, and the front desk hasn’t had the training or opportunity to research to be able to help them understand.

We’ve joked about how when customers call us at Red House, oftentimes we feel like we’re playing the role of the explainer, of the explanation of benefits, the EOB, that tells the patients the breakdown of all of this. We’re sitting there, trying to help them understand how to decipher their own healthcare. It’s quite complicated and difficult to create a clearer document because in the end, the system is set up with a tremendous amount of detail.

It behooves all of us on this side of the healthcare experience to keep our mind open to how the patient is experiencing it, how this information is hitting them, what is being understood, and what’s way over their head. The transparency is going to come from the preparation at the office and the ability to communicate one-on-one, because the documentation piece is unlikely to become simpler for the patient.

Then, we have to start talking about what that looks like for a doctor, an owner of a facility, or somebody in administration. What does that look like, to be able to train their staff? Part of that is training on the technology—having a sure grip on the EMR, billing, and any other software that are plugged into that, especially with regards to what the patient does. If the patient has a portal they log into, or if they have more than one portal, in a lot of cases, whoever is sitting there, talking to patient, needs to be able to walk them through that and break it down like they were talking to a kindergartner.

The second side of it is to understand the insurance. Someone just needs to sit down and grind out that research. That is something that can be done year over year and become better.

A practice or facility can sit down and say, “What are my top 10 payers? What are the top 10 plans that I’m dealing with? What’s coming in my doors week over week? Can I get a good feel for what these types of visits cost my patient and what I get reimbursed? What’s going to hit them when a deductible is needed?” They can just spend the time to identify their top 5-10 payers, something like that. Then they’re going to be able to train their people on it, make a printout that these folks can keep at the front desk. It allows them to have a guide for clear communication with their patients, and having clear communication is what helps the payment.

Generally speaking, healthcare is expensive, difficult, and frustrating. Nevertheless, patients do want to pay their healthcare bills, by and large. Being able to help smooth that emotional transition is where that training comes in.

I know that your team gets a lot of those phone calls and communications, so you feel that a lot. What do you guys feel like makes for good communication when it comes to frustrating bills?

Blake Walker: I think everyone dealing with a frustrating medical bill is frustrated for one of three reasons.

One is they felt like they didn’t get the service they deserved, and they didn’t get a resolution to their clinical problem. I think that’s a tough one to overcome. If the clinical outcome wasn’t a good one, I think there will be expectations that there’s going to be some frustration with the billing experience. That one’s trickier to resolve.

The other two, I think there are resolutions. One is that they’re confused and don’t understand, or don’t believe that the bill was processed correctly. If they had two payers or felt like you upcoded it, there’s some skepticism involved for most patients in that it was billed correctly. If you go on Reddit or something, you’ll see all these threads of patients saying that. And rightly so—I get bills all the time, and I’ve been doing this basically my whole life, and I’m still confused by the bills and know that they’re coded incorrectly. If I argue it with the practice, they go crazy and don’t do anything about it. You start to understand that patient’s perspective. It is a very complicated process involving a lot of money that you’re being asked to pay, and you want to understand that it was billed the right way. That’s just something where, to your point, understanding what the patients see, understanding their perspective and being able to communicate clearly with them about it, is really important in the support experience that happens when they inevitably call in and say, “Why do I owe $350 for a 10 minute visit with a doctor?”

And then the last one is affordability. We cannot overlook the reality of the situation. A family deductible is $4,000 on average right now. The vast majority of people coming to your practice don’t have $4,000 to pay you. If they’re coming out of there with an unexpected bill that they weren’t prepared for and it’s high, we have to be prepared to deal with that, one way or another. We cannot expect that they’re going to come up with $1,500 on the spot. We have to have ways to deal with that.

Ideally, we have systems that understand that a lot of patients aren’t going to be able to pay, can predict nonpayment, and can offer payment plans proactively to them automatically, so that your staff isn’t stuck talking to patients who are frustrated, desperate, and scared. Rather, the patient proactively got a payment plan option before they got to that point.

There are a lot of technology options out there that can help with that. But I think affordability is a reality that we have to wrestle with when we’re talking about patient billing and payments. That’s something that has to be baked into how we’re dealing with this. It comes back too when we’re talking about revisit payments, and we do as much as we can. Do we want to make a business decision to try to push patients to pay upfront when we know it’s possible that they might not be able to afford to pay upfront?

I think those are the things that we can prepare for as we think about how patients are going to interact with us after they leave. Are we equipped to deal with explaining their bills, clearly justifying how it was billed, and making sure they understand it?

We know what kind of codes we’re putting in for our practices. If we’re doing the same 10 codes all the time, we can probably predict what kinds of questions patients are going to have about how those were coded and billed, and then we can work through affordability problems with the patients. After the visit, those are the things that you’re going to be dealing with day in and day out: making sure that they understand the coding and billing, coordination, benefits, concerns, and then affordability.

Do we have the ways to talk to them about affordability? Do we have the tools to deal with it? Do we have ways to put payment plans in place? I think those are the big ones.

Hillam: Yeah. When I think about all of this and about deductible season as it fits into the larger ecosystem of healthcare, I think I only have one last thought that comes to me:

Here we are in the year 2024. Anybody who knows anything about this industry space knows that this was a tumultuous year—from the technology debacle, the ransomware in February that totally threw off months of payments for patients and pharmacies, some smaller follow-up technology attacks that happened throughout the year, and ending the year with simmering anger in the media with the killing of Brian Thompson. It’s important to me, when I deal with patients, that I’m aware of how complicated, stressful, and difficult this is.

We feel like it’s our opportunity to make the patients understand their healthcare because they don’t have resources. The number of Americans that declare bankruptcy for their medical bills every year is staggering. This is our opportunity to help. We are, first and foremost, here to help our clients to process their revenue, to help patients make these payments, and to make it easy. It’s our opportunity to contribute some peace of mind back into the system, where we can help our patients understand.

Like I said, they generally do want to pay their healthcare bills. They don’t have a problem with this concept. Where there is so much simmering frustration and anger right now in the system, we feel like it’s a wonderful opportunity for us to train our practices to on how to have conversations with patients that can bring some equanimity into the healthcare experience.

Walker: Yeah, I think that’s well said. I think deductible season, in many ways, is this point where we need to reconcile these two things that are pulling at each other in different directions.

One is that providers need to be able to operate businesses that are profitable. Q1 of every year is going to present a challenge where payer reimbursements are down, patients owe more money, and we need to be able to effectively and efficiently collect from patients during that time to run profitable businesses as providers and provider groups.

The other is that all of this is part of the patient experience. We’re trying to deliver healthcare services to these patients and do so in a way where everything we do with billing is a continuation of that healthcare experience, and one that can contribute to their healthcare outcomes. Whether a patient is healthy can be affected by the billing experience that happens afterwards. So we have to balance those two things and reconcile them.

I think deductible season is when it’s at its most challenging. The preparation that can go into that now, before Q1 starts, before those deductibles reset, is so important to making sure that your practice and patients are both healthy going into 2025 and every year after that.

It’s a really great topic. I’m glad it’s a term that you coined back five or six ago. So excited to be talking about it again and for more years to come.

Hillam: It was great chatting with you, Blake. It’s always good to reconnect and to touch base. Great topic for the conversation today.

Walker: Thanks Jeff.