Who’s Responsibility is it to Educate Patients About Their Insurance?

If I had a nickel for every time a patient asked me why do I have to pay a co-payment, I would be a rich person.  One would think that if they had a medical insurance plan that they would know how it works and what it covers….yes?  More times than not patients do not understand how their insurance plan works, and whose fault is it that they do not?  Is it the patient or the insurance company?  Well it is both, but they are now in our office standing in front of your check-in window and asking you or your staff questions that they should have asked the insurance company when they signed up for their plan.  What should you do?  Many medical office personnel would put it right back on the patient’s shoulders letting them know that it is their responsibility to understand what insurance plan they have, and this is very understandable.  But, lets take a moment and think about this…we have an opportunity to help educate our patients and show them that we care about them and want to help them in this confusing situation.  We work with insurance companies everyday and we understand the plans probably better than anyone, so wouldn’t be a smart for us to help our patients?  These are the people that will refer their family, friends and neighbors to our practice.   Today I had a patient call the office who has an appointment tomorrow, she received our reminder call and remembered that she had a new insurance plan since the last time she was in, she called because she wanted to make sure that we took her new insurance.  I asked her the typical questions, name of insurance, what type of plan, and then I asked if her plan had a co-payment or a deductible.  She was silent and then said “well it says I have a $500 deductible and it also says on the card something about a 20% co-payment.”  She then asked me “could you tell me what this means?, I have never had an insurance that had a deductible.”  I very easily could have told her to contact her insurance company for the details, but I did not.  I explained to her exactly what a deductible was and what the co-payment would be once the deductible was met.  She also wanted to know did that mean that she would have to pay the first $500 before the insurance paid?  I let her know “yes” that is exactly how it works, and I also let her know what our financial policy was regarding insurance deductibles.  She told me that she learned more from my 2 minutes of talking to her than from the days it took her to sign up for the insurance and get the policy into effect.  How sad…that she was so uninformed about the new plan she had, but how great that she was so happy that I took the time to explain it to her so when she comes to her appointment tomorrow she will have no surprises when she is asked to pay her portion of the deductible.  I felt great for having the opportunity to help one of our patients.  Healthcare today does extend a bit beyond medicine….it also includes helping our patients understand their financial obligations prior to their visits.

For more reading: http://pediatricinc.wordpress.com/2009/02/09/how-do-you-talk-to-your-patients-when-it-comes-to-insurance-issues/#comment-484