Don't blame the payer: Educate the consumer
Patients choose their coverage
Instead of blaming payers when benefits are denied, providers should concentrate on informing the end-users about subacute services, says Colodia Owens, BS, MHA.
"We no longer can say that the managed care entity is denying the patient benefits. Instead, we have to look at what the patient bought," says Owens, who is principal of Interface Health Care Services, a firm in El Sobrante, CA, that consults on managed care and other reimbursement systems.
That's why patients need to be educated on the front end to purchase the services they may need. Subacute care providers need to inform end-users about the benefits of services and the kind of outcomes they can expect, instead of confining their marketing to payers, she says.
Help payers inform consumers
Owens advises subacute care providers to work with payers to ensure consumers know what they're getting when they choose health care options. She compares health care to a three-legged stool - the payer, the buyer, and the provider. It won't stand without all three.
Health care providers need to start informing buyers of the choices they have when they select a health care plan, and they should start before the services are needed, Owens asserts. "Even if you don't get them until they need your services, you should not imply that their insurer isn't giving them something. Instead, you should say that you will work with them to get the most out of the plan they purchased."
What the patient bought is the crux of the matter, she says. "I love the Jaguar, but I tend to buy the Taurus - and I realize that I can't expect the same ride. I'm not comparing something as important as health care to the purchase of a car, but in reality, people are more informed about the purchase of a car than they are about health insurance."
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