Medical bills are a top stressor among patients1 and most agree that dealing with them is highly stressful and inconvenient. In fact, 56% of patients report that generally medical bills are a leading source of stress.2 Figuring out these bills is also often hard, which leads to confusion on top of the anxiety about the cost itself.3 Therefore, balance bills can add another source of stress. These are charges providers bill to patients after they pay their deductible, coinsurance or copayment and the insurance company has also paid its share.
To help lessen this stress, Claritev now offers Balance Bill Protection™ service for Vistara™. This service aims to keep members out of the difficult conversation of resolving a balance bill. We work through the provider settlement process from start to finish on the member’s behalf. Our extensive provider tools and relationships streamline the process and allow for a quick and satisfactory resolution.
This added layer of protection virtually takes away the member’s responsibility for covered charges beyond the plan co-pay, co-insurance and deductible. Balance Bill Protection also saves members time and money by removing the potential back-and-forth hassle typical of the balance billing process.
Employers and providers also benefit
It’s not only patients who feel anxiety when dealing with a balance bill. Providers don’t like to field inquiries and chase payments, which involves time and cost—not to mention the complicated administrative burden it creates. And negative billing experiences can cause patients to lose trust and switch healthcare providers. However, our Balance Bill Protection service helps to alleviate these issues by virtually removing the member and the plan from discussions with the provider after a member receives a balance bill. For employers, it can help save administrative costs and time and increases employee satisfaction. The service also may reduce overall medical costs and stop loss premiums.
When does balance billing happen?
Balance billing occurs when healthcare providers try to collect a payment for covered services rendered beyond the reasonable and allowed amount the plan covers. The member would owe any co-payment, co-insurance and deductible. This is shown as “Patient Responsibility” or a similar heading on the Explanation of Benefits (EOB). If a member receives a bill for covered services over this amount, it is a balance bill. Members don’t expect to see these charges and are often confused about whether or not they should pay them. This uncertainty can be a source of anxiety and stress. Our bold collaborative approach to reference-based pricing offers Balance Bill Protection service for Vistara to reduce the stress for all involved in such a scenario.
Remember, symptoms of stress include headache, muscle tension, fatigue and depression, all of which are bad for your overall health.4 The reason people seek care is to feel better, so balance bills should be the last thing causing them stress. Our Balance Bill Protection service is one way we strive to make healthcare a little better for everyone.
Sources
1 Wilson Pecci, A. (2021, December 17). Paying Medical Bills Can Be an Emotionally Fraught Experience, HealthLeaders Media. Accessed July 6, 2023.
2 HelpHopeLive. (2022, January 4). Key Statistics on Medical Debt—and How It Feels to Patients, Accessed July 6, 2023.
3 The American Institute on Stress. (2020, June 5). 3 ways to take the stress out of paying unexpected medical billing, Accessed July 1, 2023.
4 Mayo Clinic. (2021, March 24). Healthy Lifestyle: Stress Management. Stress symptoms: Effects on your body and behavior. Accessed July 10, 2023.
