Self-Pay Patients with Health Coverage

Posted by: Ashley Choate
Self-pay patients are becoming more common within small practice and hospital systems, due to recent changes in the healthcare market, but there are two different kinds of self-pay patients: true self-pay (with no insurance coverage at all) and self-pay after insurance.

Sometimes, patients who identify as self-pay actually have coverage or high deductible health plans, making their designation more accurate as self-pay after insurance. However, because one provider has labeled them as self-pay patients, they may assume their designation is the same with all providers.

Other factors can also influence a patient’s choice to identify as self-pay without elaborating on medical plans that may be in place, but most are not due to any deceitful intentions. Often, either they forget or circumstances have recently changed.

The key to accurately labeling and billing patients is to ask the right questions and set up support systems that make information from previous visits or within the same health system easily accessible.

Below are a few suggestions for effectively managing self-pay patients, both with and without health insurance coverage.

Create a check-in process supported by both electronic systems and staff.

A big part of effective self-pay management is clear and up front communication. This step requires a very thorough check-in and registration process. The easiest way to ensure nothing is missed during this process is to require patients to complete online or proactive pre-authorization to establish deductibles and coverage for those with health insurance or to set up clear terms and conditions for true self-pay patients.

An electronic check-in kiosk is always an efficient option, but support staff should also reinforce payment obligations with patients whenever they come in for care.

Let analytics and shared data systems work for your practice.

Some of the most promising advancements in healthcare technology today revolves around data collection, data sharing, and analytics. For instance, according to a recent Becker’s Hospital Review article, true self-pay patients pay only about 6.06 percent of their bills, while patients who are self-pay after insurance tend to cover approximately 15.51 percent on average. The percentage of costs covered by patients with high deductible health plans also tends to decrease the higher the deductible.

While these are general numbers, tracking trends within the practice allows decision-makers to focus on  ways to work with self-pay patients to ensure that bills are being covered and payment plans are arranged whenever possible. Additionally, good technology allowing for thorough checks of patient coverage can also help offset some costs by discovering ways to cover bills that patients may not have considered.

Provided flexibility in payment solutions.

Finally, self-pay patients, both with and without insurance, need reasonable options for covering the cost of their care. While the numbers are not the best at this time throughout the industry, they can always improve, particularly on a smaller scale, with realistic and flexible payment solutions.

In fact, according a 2008 McKinsey consumer survey, roughly 80% of the reasons patients gave for late or unpaid healthcare bills are addressable. In the report, the organization stated: “We estimate that if consumers had access to more convenient payment mechanisms and structured payment or financing options to help them smooth spiky medical expenses into tight household budgets, only 10 percent of their bad debt would remain stubbornly uncollectable.”

Out-of-pocket healthcare costs are unavoidably rising, and self-pay patients are no longer the exception, but the norm. Whether these patients have insurance or not, many are still affecting the bottom line for practices that have not created viable solutions for supporting these individuals and securing their understanding and payment commitments.

Fortunately, options are available for both large and small practices in the form of technology to increase efficiency, communications, and flexible financial solutions. If your practice has not created a process for self-pay patients, the time is now.

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According to the McKinsey Company, out-of-pocket costs for patients nearly doubled between 2009 and 2015, and those numbers are only set to increase. With the right infrastructure, self-pay patients do not have to be a payment collection challenge. Like any other patients, they simply want good, consistent care, which includes a reasonable approach to their financial needs. Provide that, and both the practice and the patients will be better for it.