Insurance Exchanges: 6 Crucial Questions for Physicians

Deborah Walker Keegan, PhD; Elizabeth Woodcock, MBA


October 15, 2013

In This Article

Dealing With a Sudden Influx of Patients

5. What Is the Best Way to Accommodate Patient Demand?

The good news about the insurance exchanges is that more patients may have insurance coverage and seek care from you. The bad news is that some practices may need to turn away patients due to the fact that they are "closed" to new patients or have long waits to initial patient appointments. If you want to open up patient access to your practice:

Adopt advanced access scheduling to see patients when they want to be seen. Offer an "open" schedule for some visit slots or perhaps most of the day to permit patients to be accommodated as they call for an appointment. This involves evaluating the volume of patient access requests on a daily basis and ensuring these requests can be accommodated. The extent of open slots is also dependent on your specialty.

If you have the capacity to accept patients, make sure your practice is geared to take calls and online requests from new patients seeking an appointment. Train employees to use scripts to effectively direct patients to other physicians in your practice if your schedule is full. (For example, "Dr. Jones does not have any openings on his schedule today, but his partner, Dr. Smith, has an appointment available at 3 PM today. May I book that appointment for you?") This will ensure you do not lose patients to competitors in your market.

Consider scheduling established patients only 12 weeks out and use the appointment recall function of your practice management system to schedule patients for visits beyond this timeline. This frees up the schedule to accommodate new patient demand and vastly reduces the time and staff resources to handle reschedules, which often exceed 30% of prebooked appointments.

6. How Should I Educate Patients?

Patients are understandably confused regarding the insurance exchanges. Health insurance is complicated, and the questions patients have may consume more time than you have to offer in the exam room. Here are the types of questions physicians are receiving from patients -- and how to best handle them:

My employer is no longer offering insurance, and I have been sent to the exchange. Which plans are you on so I can continue to be seen by you?

Do you think I should sign up for a Bronze plan or a Platinum plan?

Will you offer a self-pay discount if I sign up for a high-deductible plan?

Has the payer notified you of any changes to their physician network? I want to be sure I can still have you as my doctor.

To respond to these questions, it's vital to have determined the answers to the payer-related questions posed above. If you don't know which payers are part of the exchanges -- and whether you're involved with them -- you won't be able to serve as a resource for your patients.

Identify financial counselors in your practice who can take the telephone questions, electronic messages, or in-person queries from patients related to their health plan and coverage terms.

Identify the patient navigators in your area who are assisting patients with the exchange enrollment process and refer patients to them with questions regarding exchange plans. You can get a listing of support in your community from the federal Website.

Develop a Q&A brochure of the most common questions patients are asking and post it on your Website, with a link to your state exchange or the federal exchange. Revise your financial policy to ensure that patients understand common terms, such as "copayment," "coinsurance," and "deductible." Define in your policy the money that will be collected at the point of care when patients present for their visit.

The health plans provided on the exchanges offer a cafeteria of menu options related to patient premium and out-of-pocket obligations. The key to business survival in this changing world of health plans is to make sure: (1) you understand the exchange plan details and know what you will be paid; (2) the exchange subscribers understand their payment obligations and how to interact with your practice; and (3) you are ready to capture new patient volume. Above all, make sure you receive the reimbursement you expect -- and deserve.


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