Know what I owe for a healthcare visit

Market: Family healthcare managers

Scenario: A 42-year-old family healthcare manager researches potential costs before their healthcare visit and pays the copay. After receiving the bill, they wait for insurance processing, then determine the insurance contribution. They clarify questions with billing, resolve inconsistencies, and make the final payment, ensuring a clear understanding of their financial responsibility.

Average Difficulty: Medium (max difficulty scores are mostly in the 20-30% range or mostly mild with a few intense steps)

37 Outcomes 5% to 43% Difficulty

Research Insights

This study identified the most difficult aspects of understanding what family healthcare managers owe for a healthcare visit, including understanding and predicting costs, efficiently resolving billing issues, coordination between insurance and doctors, insurance complexity, and customer service efficiency. They struggle with getting clear cost estimates before visits, resolving incorrect charges, waiting for insurance payments to be processed, and navigating complex insurance processes.

Job Steps

1. Attempt to understand potential costs of the health visit

2. Pay my copay at the visit

3. Get bill from my health care visit

4. Allow time for the insurance company to process their payment

5. Figure out what my insurance paid

6. Get any billing questions answered

7. Deal with any billing inconsistencies

8. Pay my bill

Themes Identified

• Understanding and Predicting Costs: Increasing understanding of potential healthcare costs before visits, improving clarity of costs, and clarifying outstanding costs after copay.
• Efficiency in Resolving Billing Issues: Decreasing time to remove incorrect charges, reducing complexity in understanding billing inconsistencies, and shortening time to understand reasons for inconsistencies.
• Insurance and Doctor Coordination: Increasing instances of insurance breakdown arriving before the bill, improving estimates of insurance claim processing times, and enhancing integration between doctors and insurance.

Recommendations

• Provide transparent and accurate cost estimates before healthcare visits, including potential copays and outstanding costs after insurance.
• Streamline the process of resolving billing inconsistencies and incorrect charges, reducing the time and complexity involved.
• Improve coordination between doctors and insurance providers, ensuring that insurance breakdowns arrive before bills and providing quality estimates of claim processing times.
• Simplify insurance processes and provide clear explanations of coverage, claims, and payments.
• Enhance customer service efficiency by ensuring questions are answered by the first point of contact and providing visibility into the status of inquiries.

Cautions

• Avoid providing unclear or inaccurate cost estimates, as this can lead to surprises and frustration for family healthcare managers.
• Do not make the process of resolving billing issues overly complex or time-consuming, as this adds to the stress of managing healthcare expenses.
• Be cautious about over-promising on insurance claim processing times or failing to communicate delays, as this can erode trust.
• Refrain from using jargon or technical language when explaining insurance processes, as this can contribute to confusion and frustration.
• Do not underestimate the importance of efficient and helpful customer service in addressing billing questions and concerns.