Rising healthcare costs are pushing members to their limits, leaving many just one medical event away from financial devastation—even when they have insurance. Health plans are increasingly challenged to go beyond coverage and offer meaningful financial support, or risk losing trust, relevance and quality ratings. As health plans work to improve customer satisfaction—some have even begun tying executive compensation to member experience—it’s clear that the stakes have never been higher.
At the same time, employers are seeking greater transparency and affordability, looking to alternative healthcare funding models like ICHRA and other self-insured options. While ICHRAs are technically health plans, they represent a fundamental shift in how employers approach funding coverage—prioritizing cost control and flexibility over traditional group plan stability. In this environment, traditional health plans can no longer afford to simply cover care—they must help members and groups navigate the financial impact as well.
The Real Cost of High Medical Bills
A staggering 40% of Americans have experienced medical debt, and 47% of those owe more than $2,500. Even more concerning is that 86% of Americans with medical debt have delayed care because they simply couldn’t afford it. This isn’t just a member issue—it’s a health plan issue. Unresolved billing challenges lead to reduced satisfaction, delayed care, and increased long-term healthcare costs. What many don’t realize is that a significant portion of these costs could be reduced—or even eliminated—through hospital financial assistance programs or out-of-network bill review and negotiation. Yet, many members are overwhelmed by the complexity of these processes and don’t know where to turn for help.
Hospital Financial Assistance: The Overlooked Solution
Nonprofit hospitals are required to offer financial assistance to eligible patients, yet 60% of health plan members likely qualify without even realizing it. This presents a unique opportunity for health plans to step in and support members by connecting them to user-friendly financial assistance tools and offering alternative solutions for lowering bills and payments. Additionally, application complexity and stigma around receiving “assistance” often deter them from pursuing help.
By integrating tools that simplify the process and offer hands-on support during the application process, health plans can significantly reduce out-of-pocket expenses and alleviate the financial burden that can lead to medical debt and delayed care—all while easing the workload on their call center and improving member satisfaction. These solutions not only improve individual financial stability but also enhance member satisfaction, strengthen plan loyalty, and contribute to better health outcomes. Providing proactive financial assistance support positions health plans as true advocates for member well-being, reinforcing trust and helping maintain strong quality and STAR ratings.
Why Billing Errors Compound the Problem
It’s not just about debt—billing errors are extremely common, with 80% of hospital bills containing inaccuracies that inflate costs. Duplicate charges, upcoding, and incorrect service codes are just a few of the common errors that go unnoticed without expert review. Your members shouldn’t have to be billing experts to protect their financial stability.
Health plans already take measures to address payment integrity on the backend, but they could benefit from adding another line of defense—experts who specialize in identifying and resolving billing errors before they result in overpayment or financial strain. By leveraging specialized support, health plans can help protect both their own financial interests and their members’ financial well-being, ultimately strengthening member satisfaction and trust.
What Health Plans Can Do Right Now to Strengthen the Member Experience
Health plans have an opportunity to proactively provide members with the support they need to navigate billing challenges. Whether it’s helping identify billing errors or guiding them through hospital financial assistance applications, members need a plan that goes beyond coverage to truly support their financial well-being.
Taking this proactive approach doesn’t just benefit members—it also helps health plans reduce administrative burdens, lower costs associated with unresolved billing disputes, and strengthen member satisfaction and retention.
That’s why our affiliate benefit navigation company, Emry Health, created “Cutting Costs, Not Care: A Health Plan Leader’s Guide to Fixing the Member Experience.“ This guide offers actionable insights on how health plans can reduce medical debt, spot billing errors, and advocate on behalf of members to reduce costs. It’s a practical resource designed to equip health plans with tools that make a difference—without adding administrative burden.
Download the guide today to learn how your health plan can become a trusted partner in financial wellness, driving better outcomes for your members and positioning your organization as a leader in member support and satisfaction.
