Practice Notes

Help your patients understand the exchanges with a coverage FAQ

Anita Joseph

By now, we’ve heard many stories about patients unsure whether they were eligible for coverage under the health insurance exchanges. But the confusion doesn’t end at enrollment: many patients cannot determine whether their preferred providers are in their exchange network.

At a recent Medical Group Strategy Council meeting, one member said that a local insurer had sent mailings to many of its customers incorrectly asserting that this organization was now out-of-network. Another member had patients show up believing that exchange coverage entitled them to service, though the organization was not participating in any of the state exchange plans.

So how can you ensure patients know whether you're covered by their new insurance? Some of the most progressive groups have proactively targeted this information gap by posting Insurance Coverage FAQs on their websites.

The most effective FAQ lists provide comprehensive listings, offer actionable advice, and have interactive components.

1. Include comprehensive practice lists

The best FAQ lists inform potential patients of which of their practices are included in various regional and national insurance plans—often in copious detail.

On its "Know your Benefits" page, Summit Medical Group, a large multispecialty group in New Jersey, lists every insurance plan that covers its services. Some insurance plans cover only certain providers within SMG, and in these cases SMG lists out approved providers. The list of plans is thorough and lengthy, but this level of detail is often wanted and needed by confused patients.

2. Provide actionable advice

Effective FAQ pages offer specific advice to customers who have recently purchased, or are looking to purchase, plans on the state insurance exchange.

Mount Kisco Medical Group, a 300-physician independent multispecialty group based in New York, highlights the state insurance plans the group participates in at the top of its list of accepted insurance plans. The separate section is eye-catching and clear, offering direct guidance to exchange customers. Additionally, it offers a gentle push to patients to sign up for the specific plans that the group participates in on the state insurance exchanges.

3. Make the format interactive

Lastly, good FAQ lists are interactive; whether it's including a comments section that is actively monitored by a community manager or directing readers with comments to a dedicated phone line.

At the bottom of its FAQ page, ONE medical group, a concierge medical service based out of six major U.S. cities, offers a comments section that is actively monitored by a community manager. This person answers readers' additional questions within days of their original posting.

This interactivity makes it easier for patients to get more information by opening dialogue about health plans.

Thinking of Becoming a Preferred Provider?

The rise of health insurance exchanges will add another layer of complexity to contract negotiations with payers. Level the playing field by making sure you have the information needed to make the right decisions.

If you're considering becoming a preferred provider for exchange plans, download our 13-point checklist to answer important questions as you prepare for the negotiation table.

Four imperatives for navigating health insurance exchanges

James Green explains four tactics that can help your organization overcome insurance exchange challenges.

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