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Why Your Millennial Patients Aren't Paying You: Improving The Patient Experience

It wasn't that long ago that I was a stressed out patient with a mountain of medical debt and no end in sight.  Unfortunately for both me and the hospital, I was never given a payment plan option.  Had I been given multiple payment options, they would have gotten paid much quicker and I would have been a much happier patient.

If your patients' payment experience isn't an integral part of your billing process, it should be.
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“Oh, I see you have a balance,” explained the lady at the front desk.  My heart dropped to the floor knowing I had less than $200 in my checking account and had just transferred funds once again from my savings.  The sweat started flowing, the anxiety bubbling up, and it was all that I could do to keep a calm face and act surprised.  “Oh really?” I questioned, knowing very well that it was left over from that long hospital stay after becoming deathly ill from eating a raw oyster of all things. 

She must have noticed the worried look on my face.  “Don’t worry, you can pay that later,” she said. The relief washed over me.  With those few words, the sweet front desk lady made multiple mistakes:
  1. She never told me the balanced owed
  2. I wasn't given payment options
  3. She showed absolutely no sense of urgency
  4. I assumed I couldn't pay
This whole scenario had me wondering- how many front desk and back office staff members let patients skip away, showing no expectation for them to pay their balance?  Could this be one of the reasons medical practices are writing off so much of patient responsibility?  I’m all about improving the patient experience, but there must be a time when patients are expected to pay their bills, right? 

Billing staff must be educated often about discussing payment options with patients and should be giving patients every opportunity available to pay their bill.  If you don’t have multiple payment methods and tools available, you need to rethink your collection strategy.

Patients Want Payment Options

While writing checks seems like a more archaic form of payment in today’s digital (PayPal/Venmo) world, surprisingly, I still hear of medical practices who only accept checks.  These practices would rather not give up the small percentage that it costs for the merchant processing than to offer their patient’s an easier way to pay.  If you are only allowing check payments, you are letting money walk out your door.  I personally can’t tell you where my checkbook is currently hiding.  While many Americans (especially the elderly population) are still relying on using checks, digital forms of payment are increasing in popularity, especially with the increase of millennials. 

Meet the Millennials: A survey of over 1,895 millennial patients in March 2018:
  • By 2019 millennials will be 72 million strong and outnumber baby boomers
  • Nearly 3 out of 4 millennials (73%) that walk through a healthcare provider's door are already in debt
  • Two-thirds (67%) are concerned about their ability to pay a bill over $1,000
  • 71% are interested in no-interest financing for a bill below $1,000, and 72% said it was important for their provider to discuss financing options with them 
  • Only about 14% reported receiving a no low-interest financing option 
Don't stop at just allowing checks and credit cards, think about offering a no interest payment plan option like HonorCare®.  This will not only help increase and expedite your patient payments, but will also improve your patient experience, because you are giving them the tool they need to pay their medical bill.

Take advantage of payment technologies.  Think about converting from paper to electronic statements, electronic receipts, card-on-file capabilities, an online payment portal such as ImaginePayTM, and flexible payment plan options.  Allowing patients to set up automatic payments reduces anxiety caused by multiple bills piling up, reduces the amount of paper mail coming to them, and reduces the cost it takes you to actually get those patient payments.

Source: HealthFirst Financial “Meet the Millennials” Survey conducted by NBC News/GenForward University of Chicago 

Why I Don’t Want to Pay My Doctor: A Patient’s Perspective

A recent visit for an annual physical left me feeling angry, cheated, and worst of all, broke. After expecting a twenty-dollar co-pay, I was shocked to hear the administrator at the front desk utter, “And, today, you owe, $275.” My eyes grew big, almost popping out of my head, “Excuse me?” I questioned. “I’m sorry; you haven’t met your deductible yet” she explained with a smile. “I’ve seen worse,” she added. I was confused and overwhelmed by the various thoughts flooding my head. Wait a minute, I have great insurance, an awesome job, and set that money aside for a fun weekend trip to Charleston, not to give to you, I thought to myself. Of course I couldn’t tell her that. I reluctantly handed over my debit card, turned around, and waited to see my doctor. I felt slighted in some way. Why didn’t someone tell me this before I booked the appointment? Why isn’t my insurance paying for this? Do I really owe that?

Surprise Bills Are the Worst Kind.

While $275 may not seem like a lot to some, it was a shock to me, and something I wasn’t prepared for. This is an all too familiar story and a large reason why medical practices need to increase patient engagement and communication amongst practitioners. It’s beneficial to set clear expectations in regards to the patient’s financial responsibility before the appointment is even scheduled. It’s vital for everyone involved – the insurance companies, the medical practice, and especially the patient to understand what is owed. Patients are consistently confused about what they owe. Last year, 42% of consumers said they were confused by the bills they received from their providers.

If I Don’t Understand, Do I Still Have to Pay It?

Who wants to pay a bill when they aren’t sure they “really” owe what is listed on that bill? A friend of mine who recently had a baby, shared that she received multiple bills from various doctors. Now, eight months later, the bills are still being altered, corrected, and worked out by her insurance company and the hospital. Meanwhile, she’s been sent to collections, and now has a healthy baby and an unhealthy financial situation. According to the Medical Billing Advocates of America, 8 out of 10 hospital bills contain mistakes.

I Have to Pay for My Dinner, But Not My Doctor?

Due to a change in FICO scoring, medical bills now weigh less on your credit score, thus patients have even less of an incentive to pay their doctors. Working for a medical billing software company has shown me how much patient debt some practices are writing off. Meanwhile, doctors are becoming banks that provide financing for patients that are trying to pay their medical bills. Sometimes it takes patients years to completely pay their doctors, while the patients who are unwilling to pay their medical bills, or just simply can’t, are written off as bad debt with little to no repercussions for lack of payment.

Give Me Options, like Paying Hospital Bills Online

I want to pay my bill, but I’d rather do it online. My phone bill, my rent, my car payment, and even my power bill get easily through my providers' online portal. Just like choosing an affordable phone plan, residence, automobile, or setting up fixed utility payments, I should be able to pay hospital bills online. I enjoy the convenience of setting up automatic payments on a schedule that I choose. Unless it’s a personalized greeting card, I absolutely hate getting mail, where most of it ends up in either the trash or the shredder. I’m not alone! 93 percent of consumers would pay online through their provider’s or a health plan website. Providers need to understand, as a patient, we need multiple payment options and most of us, would rather pay you online.

The Struggle is Real, and How Patient Payment Plans Can Help

Even with insurance, many patients are struggling to pay medical bills. The Kaiser Family Foundation reported that one-third of Americans struggle to pay their medical bills. With increases in high deductible plans, the rising costs of prescription drugs (nearly 123.7% from 2000 to 2013), and stagnating income, it’s no wonder I’m more likely to go into bankruptcy from my medical bills than by supporting my shoe fetish. High deductible plans aren’t going away. If you don’t currently have patient payment plans options for your patients, you need to. There are many great options available to help patients pay their medical bills. Practices need to start offering these options to their most difficult payers; their patients. Just be sure to vet out these programs to ensure they have your patient in mind, and won’t hit them hard with high interest fees if they default on payments. Imagine recently launched HonorCare®, a flexible, interest free option for patient payment plans. As a patient, and someone who works closely with providers and medical practices, this is a wake up call for providers to start offering patients more payment plan options, continue increasing patient engagement, and provide patients with the most accurate explanation of what they owe.

Now, let it be clear that I’m not saying it's acceptable to not pay your doctor. My goal is to provide a unique insider’s perspective from both a patient who has experienced frustrations and confusion surrounding medical bills, and as a professional, whose daily job is helping providers and medical practices with patient collections.

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