5 Tips to Help Navigate Deductible Reset Season

Ah, the New Year: A fresh start to achieve professional business goals, improve KPIs and operate more efficiently than the year before...

However, for healthcare organizations, a new year means health insurance deductibles reset and patients become overwhelmingly aware of their renewed financial obligations. This is especially true for the growing number of people with high deductible health plans (HDHP). When health insurance deductibles reset, patients are responsible for the entire deductible amount before their insurance coverage kicks in - queue the panic.

This time of the year can be equally as stressful for call center staff tasked with fielding questions and providing critical information on which patients and providers base decisions. Below are five tips to help your call center weather this busy time with ease while also promoting a positive patient financial experience.

Tip #1: Develop scripts to navigate common conversations. 

Patients may need a refresher on what a deductible means and how it differs from the monthly premium they pay. Call center staff should also be prepared to answer questions such as:

• What healthcare services do and don’t apply to a patient’s deductible?
• What the patient will pay after meeting their deductible?
• How an individual deductible differs from a family one?
• How an in-network deductible differs from an out-of-
  network deductible?

Utilize "Top Call Generator" metrics to create scripts addressing frequently asked questions. Well-thought scripts will help your staff sail through deductible conversations.

Tip #2: Leverage technology to empower staff and improve the patient financial experience.

The easier it is for call center staff to help patients understand what they may need to pay out-of-pocket, the more focused staff can be on building patient engagement and trust. This transparency around good faith estimates is also a requirement under the No Surprises Act, the federal law that took effect January 1, 2022, to protect consumers from most instances of ‘surprise’ medical bills. Cost-predictive technology can help greatly in this area. Likewise, with the start of a new calendar year comes the need to verify eligibility. To prepare, call centers can use technology to automate and streamline many processes. This frees up their time to focus on providing meaningful patient interactions.

Tip #3: Consider call center outsourcing. 

Even call centers that are fully staffed may struggle to keep up with call volume stemming from deductible resets. Patients often have questions as they navigate new plans with new benefits and coverage restrictions. Another common reason occurs from increased claim volume following end-of-year procedures. Many patients know that once their health insurance deductible resets in January, that knee replacement surgery they’ve been putting off for months will cost significantly more out of pocket. In January, patients may be responsible for 100% of the contracted rate whereas in December, they’d only pay a copayment and/or co-insurance amount. Delaying the surgery by only one month could equate to thousands of dollars in out-of-pocket costs—particularly for patients with HDHPs.

With increased volume of procedures during Q4 of the previous year, call centers can expect an influx of patient questions during Q1 of the new year once those claims have been processed. If call centers are unequipped to handle a temporary increase in call volume, it can lead to longer patient wait times and overall patient dissatisfaction. And we all know what happens when patients are dissatisfied or don’t understand their healthcare bills: They don’t pay them. Fully or partially outsourcing your call center may make more sense than hiring in-house.

Outsourcing can also alleviate staffing shortages which continue to plague healthcare organizations nationwide. Call centers are particularly vulnerable to employee turnover because of the oftentimes monotonous nature of the work. To combat this, forward-thinking healthcare organizations are partnering with outsource companies that promote nimble staffing models and the ability to flex up or down as needed. Some outsource companies—particularly ones located offshore—often provide coverage on U.S. holidays and after business hours.

Tip #4: Focus on information integrity.

Gathering the right information at the time of scheduling has a positive downstream effect on the patient financial experience, and it may even reduce the overall call volume. Train staff to keep updating the patients’ data proactively rather than reactively. 

Tip #5: Invest in training that helps staff deliver a high-quality patient experience. 

When patients have their questions answered the first time while feeling validated and understood, they're less likely to call back a second or third time. Prioritizing first-call resolutions will help reduce the overall burden on existing staff.

For example, are call center agents trained to answer questions about available payment plans if a patient is unable to pay their entire bill up front?  With rising healthcare costs, flexible financing becomes critical. In addition, do call center staff encourage patients to consider external payment solutions like health savings accounts, health reimbursement accounts, flexible spending accounts and medical savings accounts? What about nonprofit organizations that connect patients with financial assistance programs or grants to help them pay for drug costs? Some drug companies may also offer patient financial assistance programs as well. 

Training shouldn’t focus solely on the health insurance deductible reset and its financial implications. It should also be about communicating with empathy. When patients have questions, they obviously want answers—but they also want answers delivered with empathy and understanding. This can go a long way in terms of enhancing the patient financial experience and potentially reducing overall call volume. 

Conclusion

The annual health insurance deductible reset doesn’t need to overwhelm your call center. A strategic approach that leverages technology, training, and an outsource partnership can set your call center up for success in the New Year and beyond.

Founded in 1999, Global Healthcare Resource has been a leader in revenue cycle management solutions and proudly employs 6,000+ HIPAA compliant coders, billing professionals and patient call center agents. Global operates as an extension of your office to improve productivity and increase ROI.