Why the Two Payer Market is Important

Posted on: July 24, 2017

Most Americans, even those with insurance, struggle with their cost of care. It’s an unexpected expense. When we refer to patient pay, we’re no longer talking about those without insurance, but those who have insurance and still bear a significant cost of their care. When 81 percent of single workers have an average deductible of $1,300 and 50 percent of Americans have less than $1,000 in savings, collecting becomes extraordinarily challenging.

The old view of where to spend the effort for reimbursement focused on the major insurance categories and patient pay was merely the un-insured. At the time, it made sense. Essentially 90 percent of your revenue came from payers – commercial insurance and government. The uninsured comprised only 10 percent. Those percentages have been shifting over the last few years. Patient pay has been growing anywhere from 20 percent to 30 percent. And margins from private and government payers has declined. We’re now firmly entrenched in a “Two Payer” market, where collecting patient pay is just as important as reimbursement from traditional payers.