Navigating Benefits

How Out-Of-Network Billing Education Can Save Employees From Costly Surprises


  • One in 6 insured patients will likely receive an unexpected bill for out-of-network hospital care

  • Emergency care is usually the culprit for sizable surprise charges, since employees don't check ahead to see if these services or providers are covered

  • More than half of employees are already worried about their finances, so HR departments should help employees manage surprise bills

Posted by August 5, 2019

Out-of-network billing can be an unpleasant surprise for any employee. But when someone is sick and just wants to feel better as soon as possible, going on autopilot is natural. And that’s when they end up choosing the nearest clinic, disregarding whether the provider is in your workplace benefits plan network and whether the services will be covered.

Sure, your employee will receive the care they need, but it’ll cost them. And when they’re already feeling less than a hundred percent, having to pay a hefty bill out-of-pocket just adds insult to injury.

Fortunately, with the following steps, you can help your employees stay in network and learn to manage any large out-of-network costs they might incur.

Going Outside the Network is Costly

According to a 2018 Kaiser Family Foundation study, as many as 1 in 6 insured people received an unexpected bill for out-of-network care after a hospital stay. The survey also found that emergency room admission saddles 26% of patients with out-of-network bills.

Certain providers, and the lab work and diagnostic tests they perform, just aren’t covered by an employee’s health care plan—emergency or no emergency. And when your employees incur unexpected charges, they usually end up running to the HR office in a panic. Once this happens, it can be weeks before claims are managed, and by then, the employee may already be facing collection.

According to a recent study by PricewaterhouseCoopers, 67% of U.S. workers are already worried about their finances, an ongoing source of stress that ultimately costs employers billions in lost productivity. And when a surprise bill arrives, it can just make matters worse.

But emergencies happen. And it’s the role of employers to support employees through these tough times. Here are some ways you can help staffers tackle—and hopefully reduce the incidence of—these out-of-network bills.

Make Sure Your Staff Knows What’s Covered

Employers should educate their staff about what’s covered under the group insurance plan, and not just during open enrollment.

Hold periodic meetings and distribute detailed plan documents to your employees, which cover things like surgery and associated costs, the use of emergency services, and how to determine if a provider is in-network.

Employees should also be encouraged to schedule meetings with HR if they have any questions about their coverage. Let them know the door’s always open for these confidential chats.

Guide Them Through Paying Out-Of-Network Bills

As soon as an employee brings in a copy of an out-of-network invoice, it’s time to speak with the insurance claims department to clarify the source of the charges. The employee must be the one speaking to the claims representative because of health privacy laws (HIPAA) and to answer specific questions. HR can facilitate this conversation, though.

During this meeting, your employee will be able to appeal any charges that they did not understand, that were unauthorized or that weren’t identified as not being covered. Billing errors may also be corrected during this time.

Reassess Your Benefits Plan

If there are many incidents of employees receiving surprise out-of-network bills, it could be time to reevaluate your current offerings.

For instance, perhaps covered providers could be leaving your area, resulting in more of these surprise bills. Or perhaps local health care centers aren’t coding procedures correctly or aren’t obtaining the correct referrals before employees undergo tests or other medical services.

Take this opportunity to work with the health care plan administrator to identify and to find solutions for these issues.

Legislation to Prevent Surprise Bills

Twenty-five states already have general protections to shield people from unexpected bills. And with the proposed bipartisan No Surprises Act, your employees may be able to breathe a lot easier when seeking emergency medical care. If passed, this legislation would prohibit doctors and health care clinics from billing patients for out-of-network fees.

Large employer groups are supportive of this move, with some already backing the bill in Congress. That should come as no surprise—employers want don’t want their staffers’ financial woes to impede their health and happiness at work.

Legal developments like this could be huge in helping employees avoid future out-of-network billing catastrophes. But even if they come to you with a surprise bill, when you’re armed with these best practices, you’ll be able to guide them out of debt so they can shift their focus on just getting well.

Visit United Concordia Dental’s Benefits Bridge for more tips on how to help promote financial security in your workplace.

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