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How To Explain A Balance to a Patient


Main Points

  • Be Clear

  • Be Concise

  • Be Constructive


The reality of high deductible health plans (HDHPs) is still setting in. Patients are choosing to pay less in monthly premiums in exchange for HDHPs, but this places more of the financial burdens on the patient when it comes to paying for health care. This strategy is called assuming downside risk. This means that they pay lower premiums but the downside is that they will pay more in health services.

Due to more patients assuming downside risk, providers will have to be clear, concise, and constructive when explaining balances to patients in today's healthcare environment.

Be clear! One way to be as clear as possible is to create a staff script. This will help when patients have concerns about their balance but will also help avoid staff embarrassment when it comes to asking the patient to pay her portion of the bill.

It helps the patient if you or your staff can bring an explanation of benefits or the initial eligibility and benefits check. This will help to show the patient that the practice has done its due diligence in obtaining the correct payment amount.

Be Concise! A long winded explanation of the patient's balance doesn't really help the situation. Communicating their balance in a succinct way, with supporting documentation doesn't leave any doubt in the patient's mind as to what they owe.

If they want more information or a more complicated explanation of their balance, the patient can always call their insurance company for a more detailed explanation of the bill. Remember, the responsibility is on the patient to know what they owe. You and your practice provides the service and should be paid for those services.

Be Constructive! If a patient still has questions about their bill and are refusing to pay there are several things you can do. You can develop a payment plan so that your cash flow doesn't take a big hit.

More importantly, have a credit card on file via your EHR of choice. This is the best strategy to ensuring that you get paid for your services before the patient leaves your office. The other way to be constructive is to develop multiple avenues for patients to pay. Point-of-care payment systems help to facilitate constructive payment.

It is important for your patients to pay their allotted amount even if the bill is large.

Be confident and clear and it will help your practice to thrive!


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