HPS News

In the News: The Problem of Surprise Medical Bills & How to Fix It

One of the most frustrating things for consumers of healthcare is the surprise medical bill. This is generally a bill that takes months to process before the consumer sees it. Moreover, there remains a lack of cost transparency throughout the healthcare system, leaving consumers in the dark. By the time the healthcare consumer receives that surprise bill, he or she has forgotten the details of the service and thinks all bills have been resolved, making the cost an unexpected burden.

As the healthcare industry and country collectively seek a solution to “fix” healthcare, this is one issue that must be addressed.

The root of the problem

As an industry, we need to accept the reality that the surprise medical bill issue is complicated by the fact that an entity that someone may go to for medical care doesn’t supply all bills to the consumer. Even one hospital visit can result in up to ten separate bills and patients largely have no visibility into their total cost until the bills start rolling in.

Hospitals have multiple departments, physician groups, and other entities that complete their own insurance claims and billing processes outside of the hospital. But this is much broader than a hospital system on its own island trying to solve the problem. The fact that bills can be generated from multiple locations makes the healthcare billing process more of an ecosystem than a single entity.

Regardless, there is no current widely available solution to this problem, even with the use of transparency tools and the like. Someone must take up the cause of communicating with the consumer truthfully and in a timely manner. In an industry like healthcare, there are so many beasts of bureaucracy to tame before a consumer has final costs for healthcare visits, lab charges, nursing costs, and other expenses.

And we must also consider how traditional employer insurance holders get billed, how the payer or insurer level handles claims, and how those people not utilizing traditional insurance can be helped.

A proposed solution

A possible solution could be to create, as an industry, a billing mechanism that the consumer is familiar with: almost a credit card-like experience where billings are brought together in one statement, and consumers can easily understand how and why they owe money.

The industry needs a solution in the marketplace that offers healthcare providers, who are independent from one another, the option of singular, aggregated billing to healthcare consumers. This gives consumers the ability to see which entities have provided services, how those claims have been processed through insurance, and the total amount owed for all services in a single billing statement.

The prospect of having a more consumer-friendly, all-in-one billing system will give the industry the opportunity to be in better communication with the consumer and increase the likelihood that bills will be paid. And if such a system offered consumers the ability to make payments online, they would be able to create a means to pay.

Health Payment Systems (HPS) has provided an example of this concept within the Wisconsin provider network that we have created. We pay patient claims directly to the provider, aggregate all monthly medical charges for an individual or family in a simple bill, and provide easy payment options for the consumer. Average hospitals collect 50-60% of what they are owed; we collect over 85%. That extra 30% translates into millions of dollars over the course of a year.

Next steps for the healthcare community

It is essential that the healthcare community creates an engaging and user-friendly way to create aggregate bills for consumers to eliminate the surprise medical bill phenomenon. The industry needs teams who can advocate for the consumers while working to increase the percentage of bills getting paid.

To learn more about the HPS billing and payment experience, or how we can create an independent provider network in your marketplace, please feel free to reach out to me personally.