Having a medical procedure or surgery is enough of a psychological and physical challenge already. Often, it comes with unexpected financial consequences, as well.
New legislation will increase transparency, reduce surprise billing
Starting in January 2022, the No Surprises Act began requiring group health plans and providers to end the practice of charging out-of-network rates for services provided in most emergency settings and at in-network facilities. It also established a process for the insurance carriers and providers to negotiate disputes about out-of-network charges. You can find more information at Centers For Medicare And Medicaid Services.
In addition, the CARES Act will soon require insurance carriers to provide a price comparison tool to help patients understand prices before they get care. Providers eventually will be required to notify the insurance carrier before a procedure, and the insurance carrier will send an explanation of benefits to help the patient understand prior authorization requirements and potential costs.
In the meantime, you can help employees prepare
You can take steps to improve your employees’ experience and potentially boost their satisfaction with their benefits by helping them prepare for the cost of a surgery, treatment or procedure. Consider sending an email or making a flyer to walk them through the following steps. You might even create a checklist for employees when they contact HR about an upcoming medical event.
Talk to your doctor
- What does the procedure involve?
- Are there preparations you will need to make beforehand?
- What will the recovery period look like — immediately and long-term?
- How will this affect your ability to work?
- What kinds of medicines will you need to take before or after?
Check with your insurance company
- Are the facility and providers in-network?
- Is per-authorization required?
- What is your deductible, and how much of it have you met so far?
- What is your out-of-pocket maximum, and how much of it have you already met?
- Are there applicable co-payments and/or co-insurance?
Connect with the facility
- Do they have any price transparency tools you can use to better understand the cost?
- Can you get help from their financial services department to understand how billing will work?
- When will the payment be due?
- Are payment plans available?
Understand your benefits
- What kind of PTO or other paid leave is available?
- Do you qualify for FMLA?
- What are the requirements for notifying your supervisor of your need for time off?
- What options do you have for requesting modified duty, if necessary, after your procedure?
- Contact your HR team for additional assistance, including more resources that may be available.
Doing this work beforehand can eliminate a lot of the surprises employees face after surgery and help them focus instead on healing and getting back to their normal life and work. We hope this information helps you in your role as employer and health plan sponsor.