Health Plan’s Innovative Program Takes the Headache Out of Medical Bills

Over the last few years, rapid innovation in retail and other service industries has led to a rise in consumer expectations for a better customer experience across all business sectors. Yet health care lags far behind other industries when it comes to delivering personalized, seamless interactions for consumers, especially in the coverage and payments realm. Seventy-two percent of people who utilize health care services say they are confused by the Explanation of Benefits (EOBs) they get from their insurer and 73% of people who receive medical bills say the documents don’t make sense to them. This amount of confusion about medical costs and insurance coverage can have far-reaching consequences. 

Financial stress due to unpaid bills in collections can also cause individuals to delay preventive and screening services, further impacting their health. 

Recently, the federal government stepped in to help address these issues through the No Surprises Act which went into effect at the start of 2022. The new protection bans the most common types of surprise bills, and in certain states like Arizona, there are laws in place to prevent surprise billing and provide dispute resolution for patients. Both of these legislative examples serve to ease the burden on consumers and help people plan for the cost of medical services upfront. 

Lawmakers aren’t the only ones intervening. A few select health insurance companies are also working to streamline medical billing for their members. This includes one Arizona-based health plan that recently launched a novel billing program to address the all-too-common pain points associated with knowing what they actually owe for health care services received. 

Medical billing processes are overdue for upgrades 

The first-of-its kind “frictionless billing” program is designed to make billing simple for members of Banner|Aetna. When these individuals receive health care services at most Banner Health facilities and doctors, their billing information and insurance coverage details are combined into an easy-to-read, consolidated statement. The statement details what was billed by the provider, what insurance paid, how much the member already paid, and what they still owe.

Banner|Aetna was able to accomplish these efforts thanks to its unique joint venture structure, which involves 50/50 ownership by Banner Health, Arizona’s largest health system, and Aetna, a CVS Health company. This innovative business model addresses the traditionally fragmented health care environment, where payers and providers are typically at odds, keeping members stuck somewhere in the middle. And things aren’t getting better nationally–78% of hospitals say it’s getting harder to work with insurance companies. 

The joint venture model means both partners are fully invested in creating and implementing initiatives that enhance the member experience. For example, beyond the groundbreaking frictionless billing program, this collaborative approach fosters complete data transparency between payer and provider organizations–which enables better care management and care delivery networks that help lower health care costs.

Transforming the financial experience for members

Many of the painful and complicated issues members face when dealing with medical billing stem from basic misalignment of financial incentives and lack of transparency between payers and providers. Yet a consolidated statement alone isn’t enough to transform the payment process for health plan members. Banner|Aetna members also benefit from high-touch services like a billing status tracker and a dedicated customer assistance line. 

The program’s billing status tracker feature means members won’t be left in the dark wondering about the status of their bill as it moves through the payment cycle. Instead, they’ll receive automatic notifications during key events to keep them up to date. 

In addition, if members need assistance after reviewing their bill, they can get their questions answered with just one phone call to the dedicated customer service line, regardless of whether it’s an insurance- or provider-related inquiry. This eliminates the need for the member to go back and forth between the insurance company and providers to navigate their medical bills.

The future of health care billing is truly frictionless 

Future phases of the frictionless billing program, Banner|Aetna will focus on expanding their concierge member customer service to include assistance with prior authorization, a notoriously frustrating process for patients and providers alike. (Prior authorization involves a complex data-collection process where care providers must submit a patient’s medical data to ensure insurance approval and payment of certain medical services). Other planned features in the future include attempting to add providers who perform services in Banner Health facilities but aren’t Banner Health providers, including anesthesiologists, urgent care centers, and more. 

Simplifying medical billing is a critical but complicated effort, and this novel approach to improving the experience for members is positioned to serve as a model to transform how care is billed and paid for in our industry. Banner|Aetna brings together the people who provide care with those who help patients pay. 

While many insurers and health care providers have been working to solve common consumer billing problems, their fundamental operational and financial misalignment make it extremely difficult to generate meaningful progress. It’s this collaboration between Banner Health and Aetna that gives the joint venture its unique ability to pioneer programs like frictionless billing to improve the member health care experience.