Billing remains an incredibly confusing part of the healthcare experience for Americans. In fact, research shows that most Americans do not understand fundamental health insurance terms like copay, deductible, coinsurance and out-of-pocket maximum.

“It’s a complicated environment, and typically when people are using their insurance, they’re in a state that’s not normal because there’s a health problem they’re trying to solve,” said Brad Tinnermon, vice president of revenue cycle and revenue integrity at Arizona-based Banner Health. “This tends to add a little emotion into the process. So it’s complicated, and it’s not something people use every day. So when they do encounter it, there’s usually a little education that needs to take place.”

To address this issue, Banner|Aetna (the Arizona payvider owned by Banner Health and Aetna) rolled out a frictionless billing program last week. The program is designed to minimize confusion among members by combining billing information from both the provider and payer.

With the launch of this program, Banner|Aetna is now sending its members a statement that includes billing information from providers and an explanation of benefits from the health plan all in one place. As a result, members can now view — either online or in print — the amount their provider billed, what insurance covered, what they have already paid, and what they still owe.

To eliminate any confusion that might still remain, Banner|Aetna launched a new customer service line dedicated to answering members’ billing questions. 

The program also includes automated billing and claim payment status updates. This tracker service is designed to help members feel more informed about the state of their bills after they have made payments, according to Tinnermon.

“After you receive care, there’s always that question of ‘Where’s my bill and what’s going on with it?’” he said. “So the tracker gives you updates on the bill. Has it been finalized? Has the payer identified the last amount due? Was there a denial or dispute or an issue? You can see the path that your bill is taking or learn why you haven’t seen a statement yet.”

To measure the success of this program, Banner|Aetna will track metrics such as the cost and speed of collecting payment. The health plan is aiming to reduce the costs associated with creating claims, documenting them and following up on them. Banner|Aetna is also trying to reduce the timeline of this process, because the longer it takes the health plan to work on an account, the more expensive that account becomes, Tinnermon said.

Other payers and providers have established initiatives to reduce patients’ billing confusion, but these efforts often fail to have a meaningful impact because they need operational and financial alignment between the insurer and provider, according to Tinnermon. He is speaking from experience — he said he tried for years to run a program like the one Banner|Aetna just announced during his time working at UnitedHealth Group. He also said he had been trying to establish a program like this for a while at Banner, but was only been able to achieve success by launching it through the payvider.

“This is the first functional, strong relationship between a provider and a payer that I’ve encountered in the 26 years I’ve been doing this,” Tinnermon said. “I think the uniqueness started with the executive team creating this joint venture relationship to work on this problem. The things that we’re doing are things that have been proposed for years, but there’s just been an inability for a payer and provider to work collaboratively together to get it done.”

Photo: artisteer, GettyImages