Julia Kuzel

Case Study: In an era of immediate information, delays cause patient frustration

Joanne has been active her whole life, but recently she started having knee pains, making it difficult to walk. She made an appointment and went in to visit her doctor, who took a comprehensive exam and asked about Joanne’s history. Her doctor then ordered a few x-rays. Joanna has not been to the doctor in a few years because she is healthy and hates the normal hassle associated with doctor office visits (waiting times, paperwork, insurance, short face-to-face time with the doctor). This time around Joanne was very impressed when her doctor spent a considerable amount of time explaining that Joanne most likely had osteoarthritis.

Although this sounded like a serious condition, Joanne is very confident this is manageable because her doctor took the time to explain her diagnosis, options, and develop a plan to manage her arthritis. With physical therapy and NSAID use Joanne was improving.

After 6 months of therapy, exercise, and NSAID, Joanne needed something else to help take pressure off her joints. Joanne spoke to her doctor again, this time asking for something non-invasive that could hep her get back to her active lifestyle. Joanne’s doctor prescribed an unloader knee brace.

Thankful for not needing a surgical option, Joanne thanked her doctor and on her way out, asked how much a knee brace would cost. Though the cost of physical therapy over the last 6 months was a bit high, the relief it gave Joanne was reasonable. However her employer recently switched to a high deductible plan, and now Joanne was paying for a lot more of her health-care expenses out of pocket. Based on this, Joanne wanted to know what her costs would be in order to budget (and plan for upcoming holidays). Unfortunately, because this is a piece of durable medical equipment (DME), her doctor’s office was unable to give her any information, stating it varies greatly depending on her plan, eligibility, equipment price, etc. They told her when she contacts the recommended durable medical equipment vendor, she can ask for a benefits check to get an idea of the cost.

Joanne called the DME provider to order her brace. While speaking with them, Joanne inquired about price. The DME provider said they will call Joanne’s insurance company to check her eligibility and verify her benefits. Afterwards they would call Joanne with the expected cost. The DME provider was prioritizing their caseload and could not call Joanne’s insurance company until the next day. After spending over 30 minutes on the phone via automated voice response systems and various disclaimers, the DME provider had information and called Joanne with prices.

Joanne was happy to know the cost of her brace. Some of her friends have shared horror stories about lacking clear answers until bills arrive, and even then are sometimes more confused. Joanne did have a hard time understanding why, when everything is online, it took a whole day the cost of a brace.

Patients want straight answers

Premiums and deductibles are going up, patients are acutely more aware of medical costs, and want information more quickly. However health care is mired in complexity, so it is nigh impossible to know ahead of time what costs will be. Patients may not necessarily be shopping around, but they want to be informed. The Internet lets everyone jump online and look up the price of almost anything, from flights to movie tickets, so it is understandable that patients are frustrated by inefficiencies and lack of transparency.

Next health Choice offers instant benefit information

With Next Health Choice healthcare professionals can get benefits and eligibility information. This helps patient satisfaction, and allows vendors to automate the tedious stuff. Users can instantly* view deductible, coinsurance, and remaining out-of-pocket information without having to pick up the phone. Give us a call to learn how Next Health Choice helps vendors and service providers help their network.

  • Clearinghouse data varies by payer, not all payers provide equal and detailed information. Some items that are not available immediately will be processed for rapid response.

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