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After launching Patient-Powered Search earlier this year to improve the way patients on Zocdoc find the right doctors, we turned our attention to additional points of frustration in the patient journey – and there are few things more frustrating than trying to understand insurance.

According to a Zocdoc-Kelton Global Insurance Confidence survey conducted in July, 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. Additionally, nearly 1 in 5 insured Americans have experienced issues with their insurance card, such as misplacing or losing track of it, not having it readily available, or finding it confusing and difficult to understand.

Changes in today’s insurance landscape mean that patients are shouldering more responsibility and cost for their care, and struggling to book with in-network doctors, leading to delayed care and unplanned expenses. At the same time, figuring out which doctors are included in an insurance network is a challenging proposition, underscored by frequently changing policies and plans, confusing insurance cards, and out-of-date provider directories. In short: patients need help.

Introducing Zocdoc Insurance Checker

Zocdoc Insurance Checker makes it easy for patients to decipher their insurance card, select the right insurance plan and get verified plan details before they book. We trained an artificial intelligence model to recognize the patterns of thousands of types of medical insurance cards and match them with known carrier and plan information. Now, when a patient uploads a card image, the model can identify the card, pinpoint the right plan details, and use that information to validate coverage, increasing confidence at the point of booking. We also automatically share this information with the doctor’s office, reducing manual confirmation calls and eliminating confusion about a patient’s coverage status. Here’s how it works:

1. Scan your card before you search

The top insurance carriers on Zocdoc have hundreds of available plans for patients to choose from, adding up to tens of thousands in our database. Now, when looking for a doctor in the Zocdoc app or on mobile web, a patient can take a picture of their medical insurance card instead of searching or scrolling through a long list to manually select their plan. We scan the card, extract the right information, and confirm the plan name – then save that image to the patient’s account to use for future appointments and share it with the doctor’s office.

2. See verified coverage information before you book

After a patient has selected a doctor, we’ll use the extracted information from the card, including the patient’s member ID, to perform a real-time coverage check, then confirm that the doctor is in-network, and, if the data is available*, display the patient’s expected copay.

While it may sound simple to match covered patients with in-network doctors, up-to-date insurance status is actually locked in legacy healthcare IT systems. It took months of engineering and data modeling work to decode a diverse set of cards, stitch together different data sources, and create a pipeline that turns complex insurance details into information patients can easily use. Read more about the technology here.

 

Helping Patients Deal With Rising Healthcare Burdens

According to the Kaiser Family Foundation, 81% of Americans with employer-provided insurance have an annual deductible this year, averaging about $1,500 (more than double in the last ten years, from about $600 in 2007). At the same time, narrow-network insurance plans have drastically reduced the number of providers that a patient can see.

Our survey showed that 16% of insured Americans made an appointment with a new doctor not knowing if their insurance covered the visit, and 20% have been turned away when booking with a new doctor because the doctor didn’t accept their insurance. Meanwhile, the tools consumers have to decipher coverage information are outdated and difficult to use:

  • Cards are hard to read and interpret: Only 8% of insured Americans think their insurance card is intuitive, and those who feel their insurance cards are difficult to understand are less likely to feel confident that they understand what their health insurance covers. [See our proposal for a Universal Card here.]
  • Insurance directories are often out-of-date: Directory listings contain inaccurate information, leading to legal challenges and regulatory proposals that aim to hold insurers accountable for giving patients the right information about their network.
  • Networks change frequently: About 40% of practices update their in-network plans at least once a year and, in fact, nearly 50% of patients that made an appointment on Zocdoc in 2015 would be out of network today because the patient or provider changed insurance.**

With more of the burden shifting to patients, along with fewer choices and inadequate tools, innovative new technology can help reduce insurance complexity and patient anxiety.

Doctor’s offices benefit, too. Office administrators spend nearly a quarter of their time dealing with insurance, typically making multiple calls ahead of an appointment to ensure a patient’s insurance information is valid and avoid the dreaded scenario of an out-of-network patient showing up. Insurance Checker digitally collects and verifies patient insurance information, modernizing outdated and time-consuming processes, and leaving more time for patient care.

Higher Insurance Confidence Can Create a Healthier System

Our survey revealed that if unable to book an appointment with an in-network doctor, 22% of insured Americans would skip going to the doctor altogether and 17% would go to the emergency room. Additionally, 63% of insured Americans said that if they had higher confidence in their insurance coverage, they would be less likely to avoid getting care. This critical point on the patient journey is broken, and can prevent people from getting the care they need.

With Zocdoc Insurance Checker, patients can have higher confidence that their visits are covered, start to understand plan details like copay, and make smarter decisions as they book appointments. And in the Zocdoc marketplace, they can easily find doctors that are not only in-network, but ones that are accepting new patients, with available appointment slots and great reviews. We believe that over time, applying the power of technology to insurance challenges can help create the seamless healthcare experience that modern consumers deserve.

To try Insurance Checker, download the Zocdoc app for iOS or Android: https://zocdoc.app.link/0g0y5DHXlH.

* For eligible carriers, plans and appointments

** Based on internal Zocdoc data

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