How to improve plan member experience with direct billing

October 21, 2020

Michael Bureau

To date, 2020’s main takeaway has been that life can change in an instant. The global COVID-19 pandemic has forced everyone to accept a new normal–one in which technology has become indispensable for consumers and businesses alike.

In the business community, innovative technology solutions enabled many organizations to maintain their operations and stay afloat during the health crisis. This pattern is also apparent in the healthcare industry, as mobile applications and tools that enable virtual consults with family physicians have exploded onto the scene. For its part, the Canadian private health insurance market has also rapidly adopted technologies that offer innovative, value-added services to plan sponsors and plan members. This trend isn’t entirely new though; over the past few years, insurers and health technology providers have been going through a digital transformation in order to automate processes, leverage the power of data and to improve the plan member experience. Today, more than half (54%) of Canadian employers see the value of offering digital health solutions to their workers and have indicated interest in investing more in such solutions over the next five years.

The challenge remains, however: what digital health solutions do employees truly benefit from? And what role does healthcare technology play in improving health outcomes? Some answers have surfaced over the past few months. But others have been bringing value to plan members, insurers and healthcare providers for years and continue to grow. One example of this is direct billing for plan members who need paramedical care but can’t afford to pay upfront.

Direct billing eliminates this financial burden and allows plan members to seek the help and care they need when they need it. Direct billing—unbeknownst to many—is already included in most health benefits plans, and it is free for employees. Plan members typically end up paying for the portion of the service not covered by their group health insurance plan. This saves them valuable time and upfront costs as they do not have to submit claims and wait for payments to arrive.

Avoid costly downstream circumstances.

There are other positive consequences to eliminating plan members’ need to pay upfront for care. Workers are more inclined to keep their appointments and complete full treatment cycles. An improved physical condition can help positively affect employees’ productivity at work. It can also impact their long-term prognoses, allowing them to better control future flare-ups, minimize pain, and reduce absenteeism–all without seriously impacting their personal budget.

In addition, direct billing can help facilitate access to private healthcare services, an important step in improving the overall health of Canadian workers. Access to the right treatment at the right time can help improve health outcomes for a more efficient and focused workforce. It also helps avoid costly downstream circumstances which may require high-cost drugs, leaves of absence or additional healthcare services. By encouraging early detection and treatment of healthcare issues, employers can also reduce the number of potential long-term disability claims filed by employees, since therapeutic interventions can be made well before these patients require more significant care.

Did you know?

A growing number of Canadians are asking for direct billing services. A study by IPSOS Marketing and TELUS Health found that:

50% of respondents would consider changing healthcare professionals to take advantage of direct billing services
80% believe eClaims would improve their patient experience at healthcare clinics
Nearly 70% state that when selecting a healthcare professional, the requirement to pay a share of fees up-front is a key factor

Source: IPSOS Marketing, 2018

Direct billing with eClaims.

The eClaims service is widely supported by many insurance companies, including Canada Life and Manulife, and is offered by more than 60,000 healthcare professionals across Canada.

Insurance companies who subscribe to the service cover its costs in order to stay competitive, and to reduce the volume and high costs associated with processing paper claims. The efficiency and accuracy of direct billing has a noticeably positive impact on the plan member experience. As a result, many insurers include direct billing in their standard plans.

Obtaining access to direct billing is easy. Generally, employees need only ask their healthcare provider at the end of their consult. They can also use this search tool to check whether their provider already offers this service.

The eClaims service simply makes sense. With so many advantages, it’s a simple solution to contributing to a happy, productive, and healthy workforce.