How to Help Patients Navigate Health Care Costs

How to Help Patients Navigate Health Care Costs


Rising costs and insurance literacy affect access to care and outcomes

There has been a “dramatic shift” in the way health care is paid for, reported the news website Payment responsibility no longer falls primarily on payers and providers, but rather on patients.

While health insurance coverage has increased, so have costs to consumers. “During the 2016 open enrollment period, 12.7 million consumers enrolled in a public or private health exchange program and about 90 percent of these individuals selected a high-deductible plan,” stated the article. “This has caused consumers to pay 225 percent more out-of-pocket health care costs since 2006.”

This is a concern for doctors as well, because not only are patients putting off or going without care due to cost, they are often unable to pay for care they’ve already received. “Providers only anticipate collecting 50 to 70 percent of a patient’s balance after a visit and 70 percent of providers stated that it takes a month or longer to receive the payment from a patient,” according to the article.

It’s in your practice’s best interest – and your patients’ – to help them understand and navigate their insurance coverage so they can better manage their health care costs. Here’s a deeper look at the issue.

How affordability affects access to care

Rising health care costs are causing patients to go without routine medical treatments, a survey from the Physicians Foundation revealed. Of the more than 1,500 patients surveyed, two-thirds of respondents said they are concerned with being able to pay a medical bill, and 40 percent have medical debt, reported

One in four patients have skipped a medical treatment or a follow-up appointment due to health care costs.

“Perhaps most alarmingly, one in four patients have skipped a medical treatment or a follow-up appointment due to health care costs. Eighteen percent have skipped doses of medicine, while 27 percent have avoided filling the prescription altogether.”

Health care providers are concerned that these financial barriers will affect patient access to care. “If patients cannot afford their care, they will not access it, keeping them from achieving the highest possible level of wellness,” stated the article.

The challenges of understanding health coverage

In a previous post, we discussed why helping patients understand their health coverage helps you. Unfortunately, health insurance literacy is a real problem even for insured, educated adults, as this article in the Journal of the American Medical Association showed.

A survey found that while 79 percent of insured respondents knew that a health insurance premium has to be paid every month even if you don’t use any health care services, and 72 percent could identify the correct definition of a deductible, only 51 percent could correctly calculate the out-of-pocket cost for a hospital stay involving a deductible and copay, and only 16 percent could determine the cost of an out-of-network lab test where the insurer caps the allowable charge.

A recent article in Physician’s Practice describes the challenges even a seasoned health care professional had helping her elderly father understand and access his insurance benefits. “There is a huge gap between reality and what the patient thinks happens with their insurance plan,” wrote P.J. Cloud-Moulds.

“Be patient. Be kind,” when explaining coverage to patients. “They are in pain or sick, and the last thing they want to worry about is their insurance plan.”

“When you have a patient that needs an authorization, or does not understand the difference between in-network and out-of-network status, please take the time to work with them,” she urged her fellow health care professionals. “Be patient. Be kind. They are in pain or sick, and the last thing they want to worry about is their insurance plan.”

We know it’s not possible or practical for you or your practice staff to know the details of every insurance plan. But as a doctor who is far more familiar with health insurance than the general public, there is plenty you can do to help patients, from defining basic terms – or directing them to’s glossary of health care terms – to showing them this video that helps explain health insurance in simple, visual terms.

Others ways doctors can help patients afford health care

What else can doctors do to help patients receive and pay for the care they need? Opening up the lines of communication may be the most important part. An article in the Los Angeles Times found that many patients are afraid to bring up the issue of cost with their doctors. They are either intimidated or worried the doctor will think the patient is second-guessing their judgment. But silence doesn’t help anyone.

“If the patient doesn’t say anything, we just don’t know that they didn’t get their prescription refilled because they couldn’t afford it, or … that they’re trying to take on a second job so they can pay for their surgery,” Dr. Deanna Attai, assistant clinical professor of surgery at UCLA, told the LA Times. “I can prescribe whatever treatment I want, but it doesn’t do any good if I can’t figure out a way for the patient to pay for it.”

Encourage patients to talk to you about what they can afford. You may be able to prescribe a generic drug or schedule an expensive test after they’ve met their deductible.

Encourage patients to talk to you about financial matters. Can they afford a drug or treatment? Are they concerned about cost? As a doctor, you likely know which treatments tend to be more expensive, regardless of the patient’s insurance coverage. You may also be able to prescribe a cheaper generic drug, or write a prescription for a 90-day rather than 30-day supply to lower the cost to the patient. Perhaps you can point out to them that an expensive test done in December will cost less than waiting until January because they have already met their plan’s deductible for the year.

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