Mad*Pow, the design agency that administered the “A Bill You Can Understand” Design and Innovation Challenge, conducted in-person interviews and an online survey to provide insight into the problems with medical bills. The top seven concerns are as follows.
Patients don’t know what they don’t know. Providers don’t inform patients about how their medical care and related costs are distributed among providers. Patients don’t know when and where to ask questions about decisions that affect their care and costs. Patients don’t know when a denied claim will be resubmitted, processed, and accepted.
Volume of communication. Patients typically receive many documents from payers, multiple providers, and third-party benefits managers for a single medical event. “Going paperless” can result in many e-mails from multiple sources, often containing PDF copies of the same documents that arrived in the mail or links to multiple patient portals, each requiring its own credentials.
Understandability.Documents do not provide a clear indication of how they relate to one another or how they define patient costs. The same charges may be described differently in bills and in corresponding explanation of benefits statements. The names of physicians who treated patients may not appear on bills, while the names of other physicians unknown to patients do appear. Hospitalization charges are divided into categories incomprehensible to patients, defined by the provider contracts with payers.
Terminology. Treatments are described in unfamiliar terms and payment options are written in jargon.
Timing.Payers and providers need time to reconcile claims for actual patient charges and payments. This additional time separates patients’ experience of care from bills, which can cause confusion.
Financial planning.The lack of awareness of cost before and during care means patients are unprepared for managing the final costs of care.
Trust. Payer denials and resubmissions of claims work to undermine patient trust in the accuracy of charges. Patients do not know the full cost of care, given the significant differences between the charges (reflecting chargemaster prices) and the amounts their insurance covers.
See related article: Using Human-Centered Design for Patient Statements