Published by Courtney Meade on September 25th, 2024

The only problem with a well-run employee benefits health plan is that members don’t spend much time thinking about it. If it’s working like it should, members are free to concentrate on the rest of their lives, and they don’t have to sit around memorizing their co-pays and coverage details. So, when an unexpected medical bill comes in—even if it’s been sent in error—they may not realize that there are resources available to help them challenge that bill.

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In a recent survey from The Commonwealth Fund[1], only 45% of plan participants who received unexpected bills reported that they had at least attempted to challenge them. This gap reflects a lack of knowledge and/or confidence among members about navigating their benefits and advocating for themselves. How many of those bills were coded improperly or had other errors that went unchecked? For benefits administrators, brokers, and employers alike, these findings present an opportunity to improve communication and empower members to better understand their health plans. To try and get a handle on this situation, our industry needs to foster a greater atmosphere of transparency and engage in more member education regarding health benefits.
 

Why Are Members Not Challenging These Bills?

If only 45% of respondents in The Commonwealth Fund’s survey challenged their unexpected charges, what is happening with the other 55%? Their hesitation to challenge their bills could come from several factors:
  • Lack of Knowledge: Many members are unfamiliar with their rights when it comes to medical billing. They may not know they have the option to dispute or seek clarification on charges.
  • Complexity: Navigating health care billing and insurance claims can be a daunting task. Without clear instructions or resources, members may assume that challenging a bill is too difficult or not worth the effort.
  • Fear of Retaliation: Some members may worry that disputing a bill will affect their relationship with their healthcare provider or insurance company, or they may fear additional financial penalties.
 

Four Ways Employers and Brokers can Support Members

Employers and benefits brokers play a critical role in helping members understand their benefits. By working together, they can ensure that members are not only educated about their coverage but also equipped with the tools they need to challenge charges that seem inaccurate or unjustified.

Here are a few strategies to help reduce the incidence of surprise bills and empower members:
  1. Clear Communication: Employers and brokers should work with health benefits administrators to provide clear and concise information about what is and isn’t covered under a plan. This can help reduce confusion and prevent unexpected bills.  
  2. Education Campaigns: Launching educational initiatives that explain the billing process, common pitfalls, and how to challenge a bill can be immensely helpful. Offering webinars, creating FAQ sheets, and providing easy-to-access online resources can all make a difference.
  1. Transparency Tools: Employers can offer digital tools that give members real-time access to their coverage details and cost estimates. This way, members can know what to expect before seeking care, minimizing the chances of being blindsided by unexpected costs.
  1. Encourage Self-Advocacy: By raising awareness about the resources available for challenging bills, employers and brokers can empower members to speak up when they receive an unexpected bill. This can involve offering step-by-step guides, sample appeal letters, or even access to third-party advocates who can assist in the process.


A Team Effort

Surprise health care bills are not just an inconvenience for members—they can erode trust in the benefits system and lead to dissatisfaction, lowered utilization rates, and poorer health outcomes. Employers, brokers, and benefits administrators must collaborate to help ensure members understand their coverage and know how to address unexpected charges. By prioritizing member education and fostering transparency, we can help reduce the stress and financial burden associated with unforeseen bills, leading to a better experience for all involved. Connect with us through the form below to find out more about how we can help clients and their members.
 
[1] https://www.commonwealthfund.org/publications/issue-briefs/2024/aug/unforeseen-health-care-bills-coverage-denials-by-insurers