Why is healthcare so expensive: part two

October 22, 2020
Kayla Carlough

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For our second blog in our "Why is healthcare so expensive" series, we’re going to look at patient advocacy. To clarify, patient advocacy doesn’t cause high healthcare costs, it reduces costs for patients, employers, insurers and others who pay for healthcare. When there’s a lack of patient advocacy and all that it encompasses, we see costly medical bills that could’ve been avoided.

What is patient advocacy?

In general, advocacy is helping patients make decisions or advocate for themselves with providers. Whether it’s locating healthcare resources or negotiating medical bills, advocacy is supporting patients in their healthcare journey. At Point Health, specifically, it means helping patients navigate the confusing world of healthcare. We help people locate the best and most affordable providers before a medical event, and then help negotiate out-of-pocket expenses after services have been rendered. Really, patient advocacy is offering guidance to help patients make the best decisions in their healthcare and even gain confidence and knowledge to make future healthcare cost-related decisions on their own.

Lack of health education and information leads to expensive and unnecessary care.

Most people are never taught how to play an active role in their healthcare. Not playing an active role in your own healthcare allows providers to feel comfortable running extra or unnecessary labs/imaging/etc., which leads to unnecessary medical bills. Our culture has taught patients not to question medical professionals, but it’s crucial to remember that it’s your life and your health; you have every right to respectfully ask questions and make requests.

Insurance policies are also difficult to understand. Most people can’t decipher what is and isn’t covered within their plans and oftentimes patients think because they have insurance and pay their premiums/deductibles they won’t receive other bills. Unfortunately, we know this is not true.

Another cause of unnecessary and expensive care is a lack of understanding of when to go to the ER, urgent care, or waiting to schedule an appointment with a personal provider. Many people just assume they’ll get treated the fastest at the ER and go there without realizing the cost repercussions.

Lack of price transparency is another contributor to misinformed patients. Since patients can’t see the cost of care ahead of time, they simply trust they’ll be charged a “fair amount” only to be sadly mistaken once they start receiving billing statements in the mail. Most patients are unaware of just how inflated medical bills can be.

So how does patient advocacy help patients?

At Point Health, we recognize that if a patient has come in contact with our team it likely means they are dealing with either their own difficult healthcare situation or that of a loved one. A vital part of patient advocacy is empathizing and providing a dedicated team member to provide a tailored solution to their situation. Ultimately, our goal is not only to reduce stress by helping find the cost saving solutions needed but also walking alongside these patients through their difficult season. We desire to equip patients so in the future they may feel empowered to advocate for themselves or their loved ones.

Can patient advocacy help decrease costs for employers and insurers?

Healthcare sharing groups and insurers benefit greatly from patient advocacy. When patients know the most affordable place to go to, that ends up saving their healthcare sharing group money since they collectively pay for each other’s medical bills. When you have patients playing a bigger role in their healthcare, that helps reduce costs for everyone. Patients finding the most affordable option for care can also help self-insured employers reduce their healthcare spending, and can even be financially beneficial for large health insurers.

How can patients start advocating for themselves and lower their healthcare costs?

There are several ways to save on healthcare costs, but here are a few key tips:

  • Always shop around for the best pricing - whether that’s prescription, labs, imaging, or office visits. I like to say “know before you go.”
  • Costco often offers great pricing on prescriptions and you don’t have to be a member to use the pharmacy! Consider also checking out RxSaver or GoodRx for great discounts.
  • If you end up with a large out of pocket expense, ask providers what internal programs are available. Oftentimes hospital systems offer financial assistance to those who qualify.
  • Research is important. Don’t just go to the place with the best Google reviews. Do some digging to see if driving a few extra miles to a doctor in the next town over saves a significant amount of money.
  • It never hurts to ask for a discount on your medical bills - the worst they can say is no. Most providers will give what’s called a “prompt pay” discount for payment in full.
  • Use the transparent pricing on sites like Surgery Center of Oklahoma, Colonoscopy Assist, and Healthcare Blue Book to find affordable care.

Patient advocacy is niche work that passionate individuals within a few healthcare companies are doing to help the people who are negatively affected by high healthcare costs. It’s more than just negotiating a bill down for a patient and sending them on their way. Patient advocacy is about equipping people to be empowered in their healthcare decisions and to feel confident about their health. To create a physically, financially, and emotionally healthy society, patients need to feel they can confidently and openly talk with their doctors, shop around for care to find the best option for them, and have a voice in their care plan.

Download The Patient Advocacy 2.0 White Paper

Discover what health plan members had to say about the value of patient advocacy in our survey.

Download The Sedera Case Study

Discover what health plan members had to say about the value of patient advocacy in our survey.

Download The Lowering Organizational Member Cost Guide

Discover what health plan members had to say about the value of patient advocacy in our survey.

Download the Complete Guide to Growing Your Health Plan Membership

Learn the best strategies and tips for growing your members while keeping costs low.

Download the Complete Guide to Retaining Health Plan Members.

Learn the best strategies and tips for retaining your members while keeping costs low.

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