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Premium. Deductible. Coinsurance. Co-payment. As a consumer of healthcare, can you accurately define these healthcare terms? If the answer is “no,” you are not alone.

According to a Philadelphia Inquirer article, Insurer finds need to educate public about terms, an overwhelming majority of consumers are struggling to understand these healthcare terms. In the article, one consumer is quoted as saying, “Nobody understands healthcare.” This confusion will only increase with the millions of consumers enrolling in health plans through public and private exchanges and with the tens of millions of consumers entering into high deductible health plans with narrow networks.

To address this consumer confusion, health plans are implementing strategies to educate consumers on the healthcare payments process through seminars and reading materials. However, will education solve the confusion?

Educating Consumers on Healthcare
The article mentioned above features Independence Blue Cross (IBX), a large health plan in the Philadelphia market, and their strategy to educate consumers on common healthcare terms and their role in the healthcare payments process. This strategy includes engagement educational materials and outreach events.

IBX is one of the many health plans across the country that are engaging the consumer. Another example is a Wellmark webpage that is devoted to explaining an explanation of benefits (EOB) to consumers.

Redefining Consumer Expectations
It seems logical for health plans to combat consumer confusion with consumer education, but according to a FierceHealthPayer article, Consumer engagement: Do insurers have it wrong?, education may be the wrong tactic. In the article, the writer questions if consumers want to engage health plans through educational materials and events. Further, the article finds that what consumers really want from their health plans are simple and easy transactions.

Let’s step back. At the beginning of this post, we asked you to define common healthcare payments terms, such as “premium” and “deductible.” Well, the simple answer is that all of these terms mean the same thing:

“You owe money and need to make a payment.”

Perhaps instead of educating consumers, health plans should focus on: clearly communicating payment responsibility to consumers and making it easy for the consumer to pay – irrespective of the fact that it is a provider payment or a premium payment, or the payment type is a payment card, check or even cash.

Engaging Consumers in a New Way
To consumers, the healthcare payments process can be very complex with many touch points and terms. However, consumers only need to know how much they owe and how to pay. Health plans can simplify consumer experience by integrating payment functionality within their member portals – for both premium and provider payments.

As a best practice, health plans should enable consumers to:

  1. View payments owed to all providers across multiple family members
  2. Use their preferred payment method
  3. Securely save payment information for future payments
  4. View how all provider payments affect their deductible
  5. Do this all in one place, even from their mobile phone or tablet

Furthermore, health plans should support email and text communications to consumers for balance information, payment receipts, voids, rejects and all other relevant transaction communications.

Download the latest InstaMed white paper, Challenges and Opportunities for Payers in the Changing Healthcare Payments Landscape, to explore additional challenges and opportunities for health plans as they evolve their processes, policies and offerings to accommodate for the changing industry.

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