The complicated language commonly found in health plans makes it hard for consumers to understand the coverage their plan provides, especially when it comes to determining what physicians are in-network. More than 50% of insured Americans say they have a difficult time figuring out what their insurance will cover, and 77% would like an easier way to ensure their doctor is in-network when booking appointments, according to a survey by Kelton Global.
To remedy the problem, healthcare technology provider Zocdoc developed Insurance Checker, a new feature for its Patient-Powered Search app that helps patients find a doctor. Insurance Checker enables patients to understand the coverage under their health plan by providing such information as whether their doctor is in-network and the patient’s eligibility.
Such information is important to consumers when making decisions about their care, as 22% of insured Americans would skip going to the doctor if they were unable to book an appointment with an in-network doctor, and 17% would go to the emergency room for treatment instead, says the Kelton Global survey, which was sponsored by Zocdoc.
To get information about their health plan, consumers open the Zocdoc app, select Insurance Checker and snap a photo of their health insurance card using their smartphone. Insurance Checker scans the photo to gather information on the card such as name of the insurance carrier, plan type and member identification number. Combining information from the card with information from the eligibility check and information doctors provide, Insurance Checker can identify in-network physicians for the patient. Insurance Checker uses artificial intelligence to learn how to match information from an image of a patient’s insurance card with information about his health plan, Zocdoc says.
“With more consumers having high deductible plans, staying in network when booking a doctor’s appointment is important to patients,” says Ruth Sylvia, senior product manager for Zocdoc.
Insurance Checker can also verify patient eligibility, and, if the information is available, estimate the patient’s co-pay. Confirming benefits eligibility prior to booking a doctor’s appointment ensures patients will be covered for a doctor’s visit. Of the patient’s surveyed by Kelton, 20% booking an appointment with a new doctor were turned away because the doctor didn’t accept their insurance, the survey says. In addition, 16% of insured Americans making an appointment with a new doctor did so not knowing if their insurance would cover the visit.
Confirming patient eligibility in advance of booking an appointment also benefits physicians, as doctors’ office administrators typically contact a new patient ahead of an appointment to ensure the patient’s insurance information is valid. Once an appointment is booked, Insurance Checker shares patient eligibility with the doctor’s office. Insurance Checker also saves the scanned image of a patient’s insurance card to his account for use with future appointments.
Confirmation of patient eligibility is provided by Eligible Inc., a developer of application programming interfaces for collecting medical eligibility, claims, and payments data from insurance companies.
In the first week after launching Insurance Checker last month patients uploaded more than 10,000 images of insurance cards, Sylvia says. The cost for physicians to subscribe to the Zocdoc app is $3,000 per doctor annually. The app, which is available for iOS and Android, is free to patients.
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