How to improve member experience through medical bill support
Out-of-network billing, though a smaller portion of claims than in-network, is complex and can strain resources–negatively impacting member experience.
Remote work has expanded employee locations in recent years, complicating network access beyond regional boundaries. Health plans must now address more out-of-network (OON) claims to ensure coverage and maintain member satisfaction.
From the payer perspective, navigating out-of-network claims is time-consuming and fraught with regulatory challenges, straining payers’ budgets and increasing risk for negative member experiences.
How can partnering with an external vendor for member support help payers solve these pressing out-of-network claims challenges?
The balance billing experience
For health plan members, out-of-network claims can potentially be a significant financial burden and confusing to navigate. For providers, they can demand additional billing department resources and ultimately end in uncompensated care. Those experiences can impact the relationship payers have with their customers and providers.
In addition to managing these valuable relationships, payers must keep on top of a shifting regulatory landscape across all their markets.
Developing and maintaining the specialized knowledge required to maintain positive relationships with all stakeholders and regulatory compliance is a significant task for payers operating in a resource-constrained environment.
Customizing claims support
Addressing out-of-network claims challenges, which can vary across different markets, requires specialized skills. An external vendor can bring expertise and technology to manage out-of-network claims, allowing payers to focus on core operations and balance support demands for in-network and out-of-network support.
Out-of-network member-support vendors can open the door to improved member engagement and more savings opportunities.
“From the payer side, it allows them to focus on the other things that are important, to focus on their member relationships,” says Hilary Chapman, Voice of Client Director at Zelis.
One of the most pressing challenges of the out-of-network space is its dynamic nature. The challenges can vary from market to market, and they constantly evolve. A member support partner provides a solution that scales with these changes and a payer’s needs without straining their teams and budgets.
Just as the out-of-network space varies, so do the needs of individual payers. No “one-size-fits-all” solution is the answer.
“Each health plan is unique, with its own perspective and strategies,” says Michael Chang, Vice President of Negotiations and Claims Management at Zelis. “We aim to align our tools and skills with a plan’s specific strategy to best manage their claims.”
A scalable member support solution helps payers manage their existing business and strengthens their relationships with brokers who drive new business. Brokers can show new groups how the right member support tool brings value to their members.
Finding expert compliance support
In the out-of-network space, bill assistance can help manage out-of-network claims by navigating the No Surprises Act (NSA) and state regulations, reducing administrative burdens.
“The legislation is still very fluid and subject to change,” says Carrie Gardner, Vice President of Product, Out-of-Network at Zelis. As legislation evolves, payers must continually assess their strategies to stay compliant.
A strategic partner with expertise in regulatory compliance can help guide payers through complex processes, including negotiation and resolution, minimizing risks and ensuring they stay compliant with evolving laws.
“Payers can trust that we have the scale, experience, and capacity to manage the process effectively,” adds Gardner. Working with such a partner provides payers the flexibility and resources to meet legal obligations efficiently, easing the administrative load.
Enhancing member experience
Less than half of health plan members are satisfied with their health coverage, according to a 2023 survey. Good customer service is one of the most impactful actions payers can take to improve member satisfaction.
Bill assistance solutions play a key role in addressing member satisfaction, particularly around complex out-of-network billing. By partnering with a vendor focused on out-of-network claims, payers can enhance their offerings to groups and members, providing support that educates members, ensures bill accuracy, facilitates balance bill resolution, and negotiates on the member’s behalf.
“It’s vital to have a member-centric viewpoint,” says Chapman. This partnership not only improves the member experience but also allows health plans to offer expanded services that benefit clients and their HR departments, ultimately driving retention.
“Plans focus on members first, empowering them with education to deliver a great consumer experience,” Chapman adds. The expertise provided by an external partner helps alleviate stress for HR teams by providing resources and tailored support, boosting both member satisfaction and client loyalty.
Health plans can expand their service portfolio with the right external partner and deliver improved financial outcomes, compliance, and member experiences, ultimately leading to higher customer satisfaction and retention.
