Four Mistakes My Doctors Make with High Deductible Plans

October 27th, 2014 / By Kristine Daynes

A year ago my family changed to a high deductible health plan and started using a health savings account. Because we expect to pay higher upfront out-of-pocket expenses, we pay careful attention to the network requirements and out-of-pocket thresholds. Our local providers, though, seem to manage patients with high-deductible plans as if they were no different from traditional PPO plans.

There are several things I wish my providers would do differently, and not just to make it easier for me to manage my family’s health care. My providers inadvertently increased administrative time, delayed payment, and resulted in denials and write-offs. They would do better if they adapted their processes in light of the different plan requirements. Here are four suggestions for avoiding the mistakes my doctors made with my high-deductible plan:

1. Be specific in ordering preventive services, such as annual screenings. My plan covers all preventive services 100 percent. But my primary care physician uses old forms for ordering ancillary services that describe some screenings as diagnostic tests, not preventive. She had to resend orders to an imaging center twice before the screenings got coded correctly—over three months after services were provided.

2. Review any templates or forms you use for orders and prescriptions, especially paper copies. The practice manager at my doctor’s office assumed that the forms she used in the past were correct because patients were still able to receive tests, procedures, and medications. What she didn’t know was that patients with commercial plans like mine were getting additional bills on the back end.

3. Be upfront about prices and co-pays. It seems an obvious expectation. Before services are provided, ideally before I schedule services, I want to be told the total cost and how much of the balance I will pay. With one diagnostic procedure, the total costs and co-pays I was quoted at registration were not correct. Furthermore, they included only facility fees, not professional fees, such as radiology. I only found out what I was responsible to pay when the bills started arriving in the mail.

4. Provide an itemized receipt for all services and payment. I use a health savings account to pay all out-of-pocket expenses. Although many of my providers can electronically submit receipts directly to the benefits administrator, sometimes I have to submit proof of services myself. Surprisingly, I’ve had to ask for itemized receipts from several providers. I was surprised I had to ask for them, and the providers were surprised I insisted. Some of them couldn’t accommodate the request while I was at the facility. They had to mail the receipts to me.

Over time, my care providers will adapt to the new way of doing business. They are good clinicians, and I’m satisfied with their services. I just wish it were easier to manage the business side of it.

I’ve learned to clarify orders and ask what my plan does and does not allow. But being a better-informed consumer is only part of the equation, I need my providers to be more consumer savvy, too.

One conversation with an office manager sticks with me. She said I was the only patient who thought there was a discrepancy between the preventive screenings that were ordered and the diagnostic screenings that were billed. I may be the only patient who complained about it. But that doesn’t mean the tests haven’t been incorrectly ordered and coded for other patients. I’m quite certain there are people out there paying too much toward their high deductibles because their providers don’t know they need to adapt.

Kristine Daynes is Marketing Manager for payer and regulatory markets at 3M Health Information Systems.