Medicare Gap Payments & Patient Billing Confusion
A specialist clinic provided Medicare-covered services, but patients faced unexpected gap payments—the difference between the Medicare rebate and total service costs—causing billing disputes and dissatisfaction.
Challenges
- Patients assumed full coverage, leading to payment delays.
- Lack of upfront disclosure about gap payments.
- Patients struggled with out-of-pocket expenses.
Resolution
- Implemented clear cost disclosures at booking.
- Integrated automatic cost breakdowns into appointment confirmations.
- Offered flexible payment plans for patients with financial concerns.
Outcome & Lessons Learned
- Transparent pricing improved patient satisfaction.
- Upfront gap payment disclosures prevented billing disputes.
- Structured payment options ensured timely revenue collection.