Patient Experience and Insurance Discovery: An Important Relationship

Discover how insurance discovery efforts can impact a patient’s experience & can subsequently impact a hospital’s financial health.

Modern healthcare providers know that patient experience is a cornerstone of success. Small practices and large hospitals alike benefit from assessing patient satisfaction in the quest to provide unmatched, high-quality care.

However, it hasn’t always been this way. Traditionally, many providers dismissed patient experience as an inconsequential metric based entirely on subjective feelings. Patient experience was often swept under the rug in favor of measurable, clinical-based metrics.

Studies show that patient experience plays a critical role in providing high-quality care. From booking to billing, providers can leverage tools like insurance discovery to improve patient satisfaction and maintain a healthy revenue cycle.

Why is Patient Experience Important for Hospitals?

There are two main ways in which patient satisfaction contributes to a hospital's success: clinically and financially. 

• Clinical Perspective: Patients with better experiences are shown to have better health outcomes. A patient who receives high-quality care from a team they trust is more likely to cooperate while in the hospital, attend follow-up visits, and adhere to aftercare. 

• Financial Perspective: Satisfied patients translate to repeat patients who are happy to refer others to your services, leading to filled appointment slots and increased hospital revenue. These patients also tend to pay on time and in full more often than unsatisfied patients, fueling healthy revenue recovery. After all, no one is particularly interested in making payments on expensive bills received after an experience that caused them immense stress and pain. 

What Can Impact a Patient’s Experience?

The patient experience starts when they book their appointment or walk through the emergency department doors. It continues through care and doesn’t end until the billing cycle is complete. 

This journey includes multiple factors and touchpoints with several departments. Patients place a high value on how they perceive their care, including the relationship and trust they have with their care team and the communication they receive from all departments throughout the process, including the billing team. 

A patient’s billing experience is the last touchpoint in their journey and can make or break an experience. Even the finest care can be soured by a lack of communication, incorrect billing, and extremely high charges. Without staff training and policies in place, hospitals risk delayed payments, lengthy complaints, and loss of referrals—all from one medical bill!

Several factors should be noted and closely monitored within the billing process. These elements can often lead to increased medical bills and lower patient satisfaction, but the department has the power to make and implement changes to improve success and patient experience. 

Claim Denials

Insurance companies deny claims when they don't meet certain requirements, leading to submitted medical claims being rejected. This issue arises for several reasons, including coding errors, authorization problems, or issues with patient eligibility. Coding errors often occur due to inaccurate patient information, incorrect coding, or a mismatch between services and charges. Department responses vary depending on the reason for the denial.

These denials can cause a frustrating cycle of resubmitting claims, getting rejections, correcting errors, and then waiting for a response. This cycle slows down the revenue process by increasing the time it takes to receive payments after billing. Furthermore, claims denials are becoming more common. According to a survey by the Medical Group Management Association (MGMA), 69% of healthcare leaders reported increased claim denials in 2021.

Too often, costs resulting from a denial are passed directly onto the patient without a second glance, leading to increased medical debt and a poor experience.  Teams should have policies in place to find patterns and combat denials. 

Billing Transparency & Accuracy

Patients who know and understand what they are expected to pay before receiving a service are more likely to settle medical bills promptly. This transparency means less bad debt for the hospital and fewer resources required to collect funding. 

When patients understand their financial responsibility in advance, they can plan ahead, saving any needed personal funds to handle the bill. They can also meet with financial counselors to discuss payment plan options so they feel prepared to pay. In these cases, it helps hospitals to have payment plan policies in advance with easy-to-understand patient resources.

Patients who receive unexpectedly high bills may not have these funds available or may be so troubled by the amount that they put the bill aside. They may lengthen the revenue cycle by asking the hospital for an itemized bill or asking for explanations on each item. If the patient is found to be in the right and the bill is incorrect, hospitals must then spend time redoing the bill and potentially resubmitting claims, further dragging out the process. In this case, patient satisfaction plummets. 

Some recent regulations support billing transparency and accuracy, including the Hospital Price Transparency Rule, which helps educate patients on upfront costs, and the No Surprises Act, which requires hospitals to provide good faith estimates upon request. In addition to complying with these laws, hospitals should implement tried-and-true systems for sending patients accurate financial estimates as far in advance as possible. 

Clear Understanding of Insurance Benefits

Providers can provide educational resources on patient rights, understanding medical bills, and navigating insurance. There are plenty of opportunities to educate patients and help them navigate their medical bills while increasing their cooperation, trust, and satisfaction. 

An increasing number of hospitals are going beyond traditional approaches by hiring part-time or full-time patient advocates to offer direct advice and assistance to patients. These advocates have a solid understanding of assistance programs, eligibility criteria, benefits structures, and other key areas where patients often need help.

Understanding insurance benefits is similar to providing accurate estimates and billing in that it helps patients understand their financial responsibilities early in the process. Knowing what an insurance plan covers and approximately how much this translates to in dollars allows patients to prepare for bills and pay quickly upon receiving them. 

Ineffective Insurance Discovery Efforts

An insurance discovery tool conducts a thorough scan of government and commercial insurers to identify active, billable sources of coverage for uninsured accounts. If patients have a source of insurance they aren’t aware of or didn’t report, insurance discovery is likely to find and bill it.

With effective insurance discovery, patients can avoid being buried in medical debt, an estimated $220 billion problem among Americans. 

Why Insurance Discovery Matters for Patient Experience

If a patient has a source of insurance they don’t know about, that can alleviate some or all of their financial burden, and their entire experience can change based on whether or not a hospital can find it. 

Ineffective hospital insurance discovery may overlook these extra sources of coverage, saddling patients with medical debt and leading to a poor experience. Effective insurance discovery can reduce or eliminate bills, leading to a positive experience for patients who are no longer expected to pay.

It’s common sense that patients do not want to pay more than they have to. Insurance discovery can be sure their bills are actually their responsibility. It’s an essential tool for self-pay patient management, but it can also find secondary and tertiary sources of coverage for insured patients. 

Different Insurance Types Result in a Different Patient Experience

As further proof of the relationship between insurance and patient experience, this study concluded that satisfaction with insurance type is directly associated with satisfaction with their provider.

Respondents without private health insurance were less likely to rate their provider highly than those with private health insurance. Respondents with Medicare or Medicaid were also more likely to provide higher scores. Patients who returned frequently (and likely have more medical bills to show for it) were also more likely to respond with lower satisfaction. 

There is a correlation between insurance type and satisfaction. For hospitals, it’s particularly noteworthy that uninsured patients tend to report a worse experience. With insurance discovery, some of these patients can find sources of coverage that may put them alongside insured patients in terms of experience. 

Free Insurance Discovery Assessment

Insured patients who understand their financial responsibilities ahead of time and receive accurate bills are more likely to pay and report a better experience. One of the easiest ways to find insurance and boost satisfaction is by employing Office Ally’s Insurance Discovery tool. 

Office Ally will run a preliminary assessment for free to prove our Insurance Discovery yields returns for your organization. The Office Ally pricing model is based on our performance. We only get paid when you get paid, and we always find missed opportunities to recover revenue behind the competition. 

Receive a report with results in as little as ten days and rebill claims in as little as 30. Click here to sign up for your free Insurance Discovery Assessment and move confidently into more effective, high-quality revenue recovery efforts.