A Call to Action: “Humanizing” the Billing & Claims Experience

What patients see as one unified healthcare experience is, in fact, separate and distinct. What is needed is a fundamental rethink and redesign of the billing and claims process. Hospitals can play a key role in enabling this transformation, as can insurers.

Dan Sills

Associate Director at C Space

Dan Sills produces C Space’s customer experience podcast, Outside In, which The Huffington Post called one of “The 7 Best Business Podcasts You Should Be Listening To” and Entrepreneur included in a list of “Best Podcasts for Entrepreneurs.” When he’s not locked in an edit suite, Dan talks at Story Slams and was a 2016 grandSLAM finalist for cult storytelling circle The Moth.

With contributions from Anne Pessala, Amélie Touroyan, and Bethany Klaene.

Put yourself in this situation: It’s the weekend. Your young child is playing in the backyard, climbing an old oak tree, and you hear the crack of breaking branches. You rush your child to the nearest ER, where the intake nurse, doctor, and orthopedist pull out the heroics. They soothe both of you and distract your child from the pain while operating efficiently. It’s as great an experience as a broken bone could be. And it’s over… isn’t it?

Most of the time, the answer to that question is a resounding “no,” and what follows shows there is so much more to the story:

Three months later, you receive a bill in the mail for the treatment: $1460.45. Your stomach sinks as you realize you need to make sacrifices to cover the out-of-pocket costs. The billing codes are inexplicable and you suddenly fear that you are being billed incorrectly. So, you call your hospital, get transferred, and turned away. You call your insurer, and it’s a similar story. Several weeks and many phone calls later, some charges are removed, some remain, and you feel like the stress of repairing a broken arm was less disruptive than the process of paying for it.

The unfortunate truth is that the customer experience (for both patient and caregiver) is actually compartmentalized into a “health” and then a “billing” or “claims” experience. It’s true the professionals demonstrated real care in the exam or hospital room, but the complex billing and claims process that follows can transform this positive experience into a negative, stressful one that customers are often blindsided by and unprepared for.

What patients see as one unified healthcare experience is, in fact, separate and distinct, and organized to optimize “parts” of the process – not the whole. On one side, hospitals handle intake, treatment, discharge, and billing. On the other, insurers manage referrals, co-pays, claims processing, explanation of benefits (EOBs), and provider payment. It’s a complex, fragmented process characterized by handoffs, manual interventions and rules-based decision making. At its best, it is hassle-free for the patient. When there is a problem, it’s confusing, time consuming, and frustrating.

It’s so complex that many third party groups have sprung up, acting as mediators between treatment and payment, smoothing the process over and creating a financially predictable situation for the patient. Remedy helps patients with over-billing; Zest Health helps patients understand and get the most of out of their health benefits; Simplee creates a simple, engaging, beautiful payment experience for the patient. This might work in the short term and provide a much-needed service. However, they are a Band-Aid on a broken system, adding another layer of complexity to equation. If the system worked in a way that kept patients free from the issues that rise between the hospital and insurance company, there wouldn’t be a need for these kinds of concierge services.

What is needed is a fundamental rethink and redesign of the billing/claims process. We need a transformation that aligns more closely with the patients’ view of a unified experience, and is simplified, transparent and trouble-free. Hospitals can play a key role in enabling this transformation, as can insurers.

At minimum, hospitals could inform patients of treatment costs and what is covered/not covered/in network/out of network before services are rendered (or work with insurers to do so). They could make customer service for billing easier for people to access (why is it open only from 8-4 on week days only?) with helpful staff working on a patient’s behalf to solve the problem, not just take the payment.

Insurers also have the opportunity to elevate the customer service and claims function into a strategic asset for customer retention and satisfaction. They could transform call centers by training more staff in customer empathy and giving them access to the records they need in order to be good advisors. Like the hospital billing department, they too could offer to resolve the issue on the patient’s behalf – not force the caller to straddle provider billing groups and the insurer. They could redesign EOB’s to make them clearer, easier to understand, and written in consumer-friendly language. After all, the bottom line for the patient (consumer) is quite simple: is it all taken care of? If not, how much do I have to pay, and why?

The biggest impact for improved customer experience and reduced complexity will only happen through collaboration of hospitals and insurers and others to simplify billing codes, restructure plan and payment levels, reduce handoffs and diminish the potential for human error. A deliberate redesign of the whole experience is necessary – one that creates synergies across the system instead of points of friction, or increased pain. Making progress against this goal is challenging and essential, especially in the current climate of change and uncertainly around future of healthcare. It’s time to upend a system that is ripe and long overdue for disruption, thereby allowing patients to focus on their broken bones, not a broken billing system.

You may be interested in:

C Space Hires Head of Tech

C Space Hires Head of Tech

Research Live

Global customer agency C Space has appointed Alan Zall as chief technology officer, sitting on the business’ executive leadership team. Zall was previously vice-president of North America cloud delivery at Cloud Technology Partners, which is part of Hewlett Packard. In his new role, which he started on 27th September, Zall will focus on developing in-house scalable tools to create better relationships between customers and clients.

Big Brothers Big Sisters Forges New Path with Corporate Partner

Big Brothers Big Sisters Forges New Path with Corporate Partner

massnonprofit news

What began as a corporate contribution to help Big Brothers Big Sisters of Eastern Massachusetts retain volunteer mentors during the coronavirus pandemic has blossomed into a fuller partnership that is projected to save the organization $700,000 over five years, the organization recently announced.

De-risking new launches for biotech: the customer advantage

De-risking new launches for biotech: the customer advantage

PharmaTimes

With the capital required to develop breakthrough biotech innovations, it goes without saying that when it comes time to bring these offerings to market, the stakes are high. And they are even higher among smaller biotech players, who take on an even greater amount of risk. So what does it take to create a successful product launch in biotech today? C Space Health Managing Director Corey Schwartz spoke to executives from across the biotech space to understand the barriers to successful launches, and what (customer) strategies led to their success.

Humanizing Sustainability

Humanizing Sustainability

Interview with Philipp Bolthausen, Creative Director of Baume & Mercier

Interview with Philipp Bolthausen, Creative Director at Baume & Mercier By Lidi Grimaldi and Matteo Corbellino, Express Arena Subject Matter ExpertsLet me cite Karl Lagerfeld, “Trends are the noise before defeat”. Trends are short-lived and can be extremely...

Interview with Charles Stanley, President of De Beers Forevermark

Interview with Charles Stanley, President of De Beers Forevermark By Jeanie Havens, Express Arena Subject Matter ExpertCharles Stanley’s insight into the luxury jewellery business comes from his time at some of the biggest diamond brands in the world, including Harry...

Interview with Chase Polan, Founder and CEO of Kypris Beauty

Interview with Chase Polan, Founder and CEO of Kypris Beauty By Lidi Grimaldi, Express Arena Subject Matter ExpertChase Polan is the Founder and CEO of Kypris Beauty, a beauty brand which specializes in sustainably grown botanicals, and one which has developed a very...

Generation Wealth

Generation Wealth Looking back at the ostentatious tribes of the early 2000s   By Lauren Greenfield, Director of Award Winning Ad Campaign “Like a Girl”, anthropologist and writerLAUREN GREENFIELD/INSTITUTE Xue Qiwen, 43, in her Shanghai apar​tment, decorated...

The Renaissance of “Me”

The Renaissance of “Me”  By default, we tend to look at one thing as “better than” another. It doesn’t really matter what it is. You can believe that “more is better than less”. Or “less is better than more.” It’s that one is “better than” the other. Coke is...

Introducing the Express Arena

Introducing the Express Arena By Jessica DeVlieger, Global CEOA surprising new behavioral trend has been observed in the UK; British people - a nation famously obsessed with class - are starting to hide their privilege.In January 2020, Sam Friedman, a sociologist at...