Discussing HealthShare arrangements with healthcare providers can be challenging. Providers and their staff are typically trained to deal with health insurance, rather than HealthShares. As HealthShares become more popular, the number of providers familiar with HealthShares are growing, but some may still be new to the concept.
This article will focus on billing procedures and effective communication with healthcare providers to help them understand how to bill a HealthShare and make it easier to process medical expenses.
What to know about billing with HealthShares
When considering a HealthShare membership, read its terms thoroughly. Due to the varying instructions and processes across HealthShare organizations, it is not feasible to provide an exhaustive list here that will remain accurate. Members should take notes and have them ready to share with their provider during visits.
HealthShares normally ask for itemized bills, as this lists the actual cost of every service rendered, not just the total cost of the visit—similar to a grocery store receipt that itemizes individual purchases with their respective costs, alongside the total amount. Most healthcare bills are not itemized and only show the date, location, provider name, and total cost. If patients want an itemized bill, they usually need to ask for it.
Another important detail for members to note is whether or not their HealthShare requires an itemized bill with CPT codes and/or HCPCS codes.
Current Procedural Terminology
Current Procedural Terminology (CPT) codes are numerical identifiers that categorize services into different groups (e.g. Anesthesia, Respiratory, Musculoskeletal). These codes, published by the American Medical Association and most recently updated in September 2020 (CPT-10), provide a standardized system for categorizing services. Providers are typically familiar with CPT-10 and can convert codes if necessary, but members should confirm the version required by their HealthShare.
Healthcare Common Procedure Coding System
The Healthcare Common Procedure Coding System (HCPCS) system includes the CPT codes. In fact, CPT-10 and HCPCS Level I are the same thing. However, HCPCS also has Level II codes for additional categories like transportation, medical supplies, and medications. Level III codes are for localized programs and are not widely used. If a HealthShare requests HCPCS codes, members can assume that they want CPT codes or HCPCS Level II codes. The staff at any provider office should know what these codes are and be able to produce codes for any procedures or services they render.
Talking to healthcare providers about HealthShares
When communicating with healthcare providers, patients should approach the conversation as advocates for their own care. Members should make the effort to be proactive in obtaining bills and receipts from providers and submitting them to the HealthShare promptly.
Showing a helpful and cooperative attitude towards providers, who often experience heavy workloads, can make a difference. Patients can demonstrate their commitment by providing accurate information, maintaining a positive demeanor, and offering assistance in obtaining any necessary information from their HealthShare.
Members can build provider trust
Patience and cooperation play an important role in productive discussions with healthcare providers. If a provider initially demonstrates a negative opinion of HealthShares, a member may need to take their time to establish trust. Building a relationship based on trust is important in the doctor-patient dynamic.
Most doctors care about their patients and want to help them use the payment options that work best. However, HealthShares may be confusing or concerning to a medical professional who has only ever dealt with health insurance. The way HealthShare members interact with a concerned or confused provider can help alleviate potential concerns about getting involved with a HealthShare.
By working together, patients and providers can navigate the intricacies of the new and fast-growing HealthShare industry, ultimately leading to improved healthcare experiences for all.
