How our patient advocates support us during unexpected surprises
We often assume that the reason medical bills go to collections is an inability to pay. While medical debts are high — and on the rise in the U.S. — a lack of financial resources is not always the root cause of a bill being sent to collections.
At Cedar, we have a dedicated team of patient advocates who help our patients decipher questions about their bills, working with them to make payments on time in ways that are most convenient. And as a designer for our provider-facing product, my job is to help improve the tools that our advocates use.
Catching an uptick in collections
Earlier this year (and in the midst of COVID-19), our provider clients noticed an uptick in bills ending up in collections. This is obviously challenging for patients, as being sent to collections can hurt credit scores in the short term, as well as lead to long-term financial instability. It’s also frustrating for providers since when bills go to collections, the payments are no longer accepted through Cedar and instead transferred to a third-party collection agency.
In order to understand why we were seeing this uptick, Cedar’s design team began shadowing our advocates, so we could better understand their interactions with patients, and how we could potentially mitigate this issue. Here is what we learned.
It can happen to anyone
After listening to a few sessions, I began to identify two types of patients interacting with advocates. The first group of callers was those who had trouble paying their bills prior to the pandemic; these patients are likely to have higher bills and inconsistent incomes, which can make monthly payments difficult. And they are often calling to reduce their recommended payment amount or even stop their payments, even at the risk of being sent to collections. These difficult calls can get uncomfortable, as patients think there are no other options. But, at Cedar our advocates are able to help, whether it’s through re-working a payment plan, escalating to the provider, or assisting them with financial aid.
However, it was the second group of patients that surprised me, as they were not aware they even had a bill in collections. Based on previous research we’ve conducted, we would call these people “planners” and “seekers.” These patients tend never to miss their bills, understand their invoices, and know the healthcare process inside-out. And they are often alarmed when speaking to our advocates.
“…It is common to get upsetting calls from patients who didn’t know their bills are in collections… What makes it worse is that they are small enough to pay and shouldn’t be there in the first place!” — Paul, patient advocate
Our opportunities to help.
So how do those who are willing and able to pay still have bills that end up in collections? Research and shadowing sessions helped our team identify these gaps and rethink how we build our future tools for our representatives to decrease patents bills falling into collections.
Patients aren’t always aware.
“There are other ways bills can end up in collections…And it’s not the caller’s (patient’s) fault” — DeAundrea, patient advocate.
During our research, it’s surprising how often patients find out about these bills through unexpected mail from a collections agency or by pulling their credit score moments before making a significant purchase. Even more surprising was that the majority of these bills were lower than we anticipated, and patients were ready and able to make good on their payments immediately. But because the bills had been transferred out of Cedar’s system, we could no longer accept those payments.
According to our recent Healthcare Consumer Experience Study, nearly one-third of patients who went to collections said it was due to billing mistakes, followed by an invoice confusion (28%) and outdated billing processes (24%).
That’s why we are proactively exploring new ways of communicating so that bills don’t end up in collections. By identifying accounts that are near or have outstanding bills to improve connections with patients earlier. whether it’s building a team of financial representatives, intuitive notifications, or even from a robot.
Patients are on the move.
We were also surprised to find out the number of bills that go to collections due to having the wrong home address on file. Our representatives get hundreds of calls every week, and each call starts with an authentication process, usually verified with one’s home address. And that’s where things can go wrong.
The pandemic has been a life-changing event for everyone, with many people rethinking their lives and moving their families. And many older patients rely only on mailed paper statements or landlines that can lead to missed bills.
“Even when they (providers) sent the invoice and it ended up taking a while for it to get to my new address, and then by that time I was kind of overwhelmed with other bills…” — anonymous patient
Understanding this discrepancy allowed us to enable our advocates with the tools to proactively confirm and collect key information so that no patient falls through the cracks.
Patients create payment plans to “set it and forget it.”
Finally, a large number of patients were creating automatic payment plans, where a set amount is paid every month or bi-weekly. These plans are created to give patients peace of mind about their bills, as they can set an amount to automatically pay. However, late additional invoices are an increasingly common cause for bills being sent to collections — especially because these additional bills are not added to existing payment plans.
So why are there late bills, and why are they on the rise? To start, It’s possible to receive multiple medical services after just one visit, and some of the bills can arrive over a lengthy period of time. On top of that, additional delays from insurance verification and pandemic backlogs calculating insurance, and backups from the pandemic can leave patients waiting for months on end about how much they actually owe.
Patients shouldn’t be responsible for making sure all their invoices are in order before making a payment, and they shouldn’t be penalized for late additions. Instead, we now make it possible for patients and reps to automatically add any new invoices to their payment plans (without increasing the monthly payment amount), to make sure these bills get paid on time.
Shadowing our advocates has been an eye-opening experience, allowing us to see the gaps that cause patients to end up in collections — and how we can bridge those gaps. Patients want to pay their bills, and we want to make the process as easy and as stress-free as possible. Which is why these small but necessary changes are so important in enabling our patient advocates to best help every patient in need.
This article is part of our #Moneytalk series from the Cedar design team, which focuses on how to talk to patients about money. If you missed the previous posts, read them all here.
