Balancing the unknowns of healthcare billing with the No Surprises Act

John Talaga
John Talaga
is the Executive Vice President and General Manager in Healthcare.

In my last post, I wrote about the No Surprises Act, its many benefits for patients, and some considerations for providers as they implement it. I wanted to expand on that here.

The No Surprises Act could not have come soon enough. Flywire recently surveyed over 2,000 consumers in the US to understand how they were managing healthcare costs. 46% said they would not be able to pay for an unexpected illness or surgery in one lump sum. That’s an alarming reality that the No Surprises Act addresses head on.

But there are some things the No Surprises Act simply can’t solve for. Primary among them is that healthcare billing will almost always be full of surprises because there are so many unknowns involved.

As a consumer, you typically know what you’re buying, and how much it will cost in advance of making a commitment. And you don’t receive those goods or services until you’ve either made a payment, or committed to it. Not in healthcare. Rarely do the patient or the provider know exactly what is being purchased at the time. A lot can change from scheduling to consultation to diagnosis to treatment and post-treatment. In some cases, the patient may be medicated, under duress, or even unconscious during the initial interaction with the provider. They may have very little control over what products or services they receive. And there are almost always additional charges which need to be collected after the service is delivered. This is just the reality of healthcare.

Despite all these variables, there are a few things providers can do to eliminate some of the surprise factors. And these are entirely consistent with the goals of the No Surprises Act:

  1. Provide a cost estimate for the patient’s upcoming visit so they understand upfront what they can expect to pay. And, allow them to set a payment arrangement to alleviate the stress of payment so they can focus on their health.

  2. Wherever possible, present patients with a consolidated view of all of their expected (and incurred) charges from individual service providers on one statement so patients can see everything they are responsible for in one place. This prevents confusion, eliminates surprises, and helps patients plan how to pay. In the Flywire survey referenced above, 74% said a consolidated view of their healthcare bills would be beneficial for budgeting.

  3. Provide convenient online payment options that streamline things for your patients and your finance team. Make it easy for everyone involved to track what payments have been made and what is still outstanding.

  4. Offer flexible, self-service payment plans to reduce the financial burden for patients. And make them tailored to a patient’s financial circumstances. This can help offset surprise balances that result from some of the unknowns discussed above. 77% of the consumers Flywire surveyed said they would want to pay an unexpected medical expense in installments or under some type of payment plan.

We can’t eliminate all the surprises in healthcare billing, but we can take steps to ease the burden when surprises do happen.