Is the insurance boom going bust?

What urgent care centers need to know as patients drop coverage or opt for high-deductible insurance plans

Aniela Johnson took the patient’s insurance card when he came in for treatment at Zip Clinic Urgent Care in Denver. But when the center sent the EOB, it was denied for “no coverage.”

“The patient had stopped paying his premiums. His coverage was dropped,” said Johnson, general manager at Zip Clinic.

As open enrollment season gets into full swing this month, clinicians need to recognize this trend: Many Americans, especially those on the new exchange, are dropping health care coverage.

In 2015, 22 percent – about 2.8 million people – enrolled in an exchange plan and later dropped it. This means a rising number of uninsured patients are coming through the doors of medical offices nationwide. HCA Holdings Inc, the largest U.S. for-profit hospital chain, reported a 13.6 percent rise in the number of uninsured patients seen in the third quarter. The company’s chief financial officer attributes it to non-payment of insurance premiums.

Why is this happening? There’s mounting evidence the Obamacare system is slowly unraveling as consumers are hit with health insurance sticker shock. And urgent care needs to prepare for the fallout.

The growing number of uninsured and underinsured consumers could shrink the number of patients seeking urgent care, which is exactly the opposite of what was intended by expanding insurance coverage.

Insurance is designed to protect people from unexpected expenditures that could wipe out their savings or limit the ability to seek needed treatment for a major illness. With this concept in mind, many of the “new” insurance plans offered through the exchange or by employers come with high deductibles, co-pays and/or co-insurance to keep premiums more affordable by shifting the cost of routine care to patients.

The goal is to drive patients to educate themselves on costs and services, to choose judiciously from among health care options. Educated consumers could be good news for urgent care, which offers an on-demand treatment option for minor conditions that’s less expensive than hospital emergency rooms.

Many of the health insurance plans offered in the marketplace and through employers feature high deductibles. The average “Bronze Level” plan in the marketplace carries a $5,000 individual/$10,000 per family deductible. Many individuals with employer-paid insurance are seeing deductibles ranging from $1,000 to $2,500-plus for an individual, twice that for family coverage.

Many Americans continue to struggle economically. And the value-driven populous feels cheated when faced with large medical bills, due to high deductible responsibilities, after a visit to the doctor.

In the past, Americans were used to presenting their insurance card and paying only a token co-pay whenever they wanted to see the doctor. Today, these same consumers are paying insurance premiums but also paying the entire cost of their routine visits. This leaves consumers asking: What is the value of these rising premiums I’m paying? Many decide to play the odds and drop coverage. They also realize they could get coverage later on with no pre-existing condition limitation.

Here are some steps urgent care centers should take to protect themselves in this changing market:

• Bill at time of service. Use real-time eligibility – an online verification of patient’s deductible and co-pay – to determine what a patient owes base on his coverage plan. If he has a high deductible, collect payment up front
• Eliminate backend billing surprises by educating consumers on their financial responsibility. This entails training front office staff on insurance terminology, revenue cycle management, and giving them the tools and collateral to communicate with patients.
• Take a pre-authorized credit: A few medical billing software programs now offer credit card pre-authorization (automatically charging any patient balances after an insurance claim is adjudicated). This can facilitate better communication with patients and assure timely payment.