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High-deductible health plans: Coping with payer restrictions

Patient Access Weekly Advisor, September 26, 2007

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About 31% of large employers-those with 20,000 or more workers-offer HDHPs to their employees, according to a 2006 Mercer Health & Benefits survey.

Determining whether a patient has met his or her deductible is difficult enough without technology to speed the process. But when a payer's policy restricts you from attempting to collect monies up front, your team is playing shorthanded.

"Your best chance of collecting money is when the patient is standing right in front of you," says Robin Fisk, Esq., a lawyer in Ashland, NH. "When a payer takes that away from you, particularly in respect to [HDHPs], it causes big problems."

For a proactive approach to the issue, Fisk makes the following suggestions:

1. Meet with your managed care director to review the dozen or more managed care contracts that you have on file to see which currently allow, or could allow, HDHPs. Jump into the policy details and identify what restrictions each payer has in regard to up-front collections. "You can offer some [patient access] feedback that the managed care staff can use in future negotiations," Fisk says. "Give your best price to the products that make it easier for you."
2. In the short-term, take your list of payer requirements and train registration staff on how to approach the different collection scenarios. In the absence of payer technology to immediately determine whether the patient has met his or her deductible, your registrars must be able to identify specific payer restrictions for the patient who is standing in front of the registration desk.
3. The most basic-yet important-step is patient education, Fisk says. Patients must understand exactly what it means to belong to a HDHP and what that membership requires of them. Fisk says, "Consider taking credit card information and a credit card number and explain why you're doing that. If the patient hasn't met the deductible, the payer doesn't have to pay dollar one."

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