WATERTOWN, Mass.--(BUSINESS WIRE)--A visit to the doctor’s office often includes the moment when the patient is asked if they have a co-pay and the amount. With numerous health plan options available to consumers and the growing popularity of tiered network plans, this question is no longer as straightforward as it once was. Sometimes neither the patient nor the health care provider knows the answer. Co-pays now vary widely based on a combination of factors that can lead to confusion. To help remedy this, Tufts Health Plan created a new tool for providers that accurately determines a patient’s co-pay in real time and based on their specific plan information.
“This tool has been extremely helpful in helping us manage patients as they enter the door,” said Sabrina Latimore from Mount Auburn Hospital. Latimore manages the Pre-Admission Review Department. “It can be confusing trying to determine what the patient’s cost-share is, this tool provides clear and concise information and lets us focus on what matters most: the patient’s health. Tufts Health Plan has been a great partner by listening to our needs and proactively providing us with a tool that allows us to be more efficient and to better serve our patients.”
Tufts Health Plan currently offers a variety of tiered plans on the market. In tiered plans, hospitals and physicians are grouped into different levels or ‘tiers’ and members pay different amounts for co-pays, coinsurance and deductibles based on the tier designation of their health care provider. If a provider cannot determine accurately what tier they are in relative to their patient’s health plan, they may charge the wrong co-pay amount, leading to the patient overpaying or the provider being underpaid – resulting in frustration for both parties involved.
“Tiered network plans were created to reward quality and help decrease health care costs – ensuring value for members and employers. However, these types of plans are still new to market,” said Marc Spooner, Tufts Health Plan’s president of commercial products. “We began hearing from providers that a major pain point was determining the correct co-pay amount for their patients – and we decided to take action.”
Tufts Health Plan proactively created this new provider co-pay tool to meet the needs of providers and their patients. The Plan held focus groups and surveys of providers to hear their feedback on the program and continue to make modifications and improvements based on ongoing feedback from providers. Some of the positive feedback included providers saying:
- “We trust the information that we receive from the website. We have never had an issue with incorrect co-payment information that we have given to a patient.”
- “Great information to be able to help member with questions they may have.”
- “Tufts Health Plan provider portal is an easy system to use, takes a couple of clicks to locate information. Good two way system of locating a patient.”
- “Incorporating the actual costs of things like cardiac rehab, pain management and sleep studies has helped us better serve our patients.”
Continued Spooner: "With our new tool, the guesswork is eliminated. Providers have the confidence of knowing the correct co-pay amount to collect from their patients and our members. As a result, the overall experience is improved for the physician, their office staff and the patient.”
The new Provider Co-pay Tool, available for providers through the Tufts Health Plan Provider Portal and through a standard eligibility and benefits EDI transaction, supports providers in Tufts Health Plan’s commercial products network and is in line with its overall goal of providing more cost and quality transparency for members, employers and providers. The plan is achieving this through the creation of innovative Cost & Quality tools including the introduction of EmpowerMe, an online cost estimator that allows members to more effectively manage their health care costs by providing highly personalized cost information on their medical treatments and out-of-pocket expenses. Additionally, Tufts Health Plan recently enhanced its existing ‘Find a Doctor’ search tool to include quality and cost information that can be accessed by members.
About Tufts Health Plan
Founded in 1979, Tufts Health Plan is nationally recognized for its commitment to providing innovative, high-quality health care coverage. Touching the lives of more than one million members, Tufts Health Plan serves members in Massachusetts and Rhode Island, offering health care coverage regardless of age or circumstance.
Tufts Health Plan continually ranks among the top health plans in the country based on quality and member satisfaction. Its private HMO and PPO plans are rated 5 out of 5 by the National Committee for Quality Assurance*. Its Medicaid plan is rated 4.5 out of 5.** Its Tufts Medicare Preferred HMO and Senior Care Options plans earned a 4.5 star rating - based on a five-star scale - from the Centers for Medicare and Medicaid Services for 2015.
* The National Committee for Quality Assurance (NCQA) Private Health
Insurance Plan Rankings 2015-2016.
** NCQA’s Medicaid Health Insurance Plan Rankings 2015-2016.