More than half of Americans have delayed healthcare in the past year due to financial burdens. Patients are skipping important annual visits, cutting pills in half to make them last longer, or ignoring signs and symptoms in fear of the cost setbacks.
A study conducted by the Kaiser Family Foundation and Los Angeles Times found that patients’ top consideration when choosing healthcare coverage is now cost, including premium, deductibles and co-pays — as opposed to providers or breadth of benefits. As a result, more patients are forgoing follow-up appointments, maintenance screenings and other preventative measures.
The good news is providers can step in to help patients minimize or eliminate out-of-pocket costs. How?
“Learn the language of the insurance companies,” Richard Ohnmacht, MD, FAAP, tells Florence Health. Dr. Ohnmacht, rated the best pediatrician in Rhode Island, sees patients whose families struggle with finances often. “If you miss a certain word or phrase, a treatment may not be covered,” he adds.
Here are six ways providers can help patients afford expensive treatments or medications.
Recommend patient assistance programs
Patient assistance programs, run by pharmaceutical or medical supply companies, government organizations and nonprofit groups, help patients and families afford or access expensive medications or supplies. Make sure your patients have an up-to-date medication list, and for those who don’t have regular access to computers or phones, suggest they work with a navigator, social worker, or another specialist.
Popular patient assistance programs include:
- Center for Benefits
- Social Security Extra Help Program
- Medicare State Pharmaceutical Assistance Programs
Request free samples of medications or supplies
Many pharmaceutical companies like Pfizer and GSK allow providers to request products or coupons online. For products that patients may not be using much of, like creams or topicals, a sample may be several doses worth.
Learn specific insurance language
Because insurers are looking for reasons not to pay for care, providers need to explain exactly why their chosen treatments are necessary.
For example, “If I write down that a patient needs a certain medication or service because they have ‘Down syndrome,’ they may not be approved,” Dr. Ohnmacht explains. “But, if I write that ‘because of their Down syndrome, they have visual and auditory deficits, and the literature proves that those with these deficits benefit from this therapy,’ then they will be approved.”
When you’re learning the ropes, check out the Patient Advocate Foundation, which offers tips for appealing denied insurance claims. Individual insurance companies also often have resources for providers to review claim information and how to submit. Asking a fellow provider who deals with a similar patient population is another good place to start.
Ask patients upfront about cost
Patients may not be forthright about requiring assistance for a certain drug or service. If you know that you need to prescribe an expensive medication or refer a patient to a specialist, take special considerations.
First, ask the patient if he or she will need help paying for this treatment. Then, try to connect the individual to a patient navigator. You may also consider changing the type or strength of drug so it’s covered by their insurance.
Sometimes, just asking up front can solve problems down the line.
Refer your patients to a local community health center or clinic
Depending on a patient’s copay or deductible, specialist visits may be a big out-of-pocket expense. Dr. Ohnmacht suggests referring patients to a community health center if insurance becomes an inhibiting factor. These facilities often provide patient navigators and outreach programs and are usually looking for other institutions to partner with.
Review insurance-specific drug approvals
Often, insurance companies have specific rules for coverage of certain medications outlined in their drug formulary or coverage library. Maybe extended release Metoprolol is covered but short-acting is not covered and your patient can take either form. Reading the fine print may not be the most exciting task, but it can save your patients thousands on prescriptions and supplies. Prioritize the common insurance companies in your area and the most expensive medications you frequently prescribe.
To practice patient-centered care, providers should make a habit of helping patients access their treatments. Not to mention, this is a much-needed service: More than 25 percent of insured Americans struggle to keep up with routine healthcare bills, and almost 30 percent of U.S adults say they don’t medications as prescribed due to cost.
As providers, we should learn the language of insurance companies, being up front about cost, and using resources like RxAssist, the Patient Advocate Foundation, and community health clinics can help patients get the care they need without forcing them to make tough financial decisions or skip necessary treatments.