Walmart Health employees report hurdles with billing payers, patients overpaying

As Walmart Health clinics are poised to provide low-cost and convenient healthcare appointments, the retail giant is struggling with basic operations such as price transparency, billing and credentialing physicians, according to a Sept. 29 Insider report.

Walmart opened 20 primary care clinics in Texas, Georgia and Illinois within the last two years. More than 230,000 patients have visited the clinics as the retail giant also plans to push into more states, with plans to open seven locations in Florida, Insider reported.

Eight current and former Walmart Health employees told Insider that operations issues have inhibited Walmart's ability to improve healthcare for patients.

"The billing is horrible," said Dominique Stewart, a former administrator at one of Walmart Health's Georgia clinics told Insider.

One current and five former Walmart Health employees told Insider that the retail giant has trouble verifying patients' payer eligibility to determine coverage and out-of-pocket expenses. Some employees said the tool Walmart uses to verify payer eligibility is inaccurate and costs patients more than they should have owed, according to the report.

"Patients were overpaying. Like you'd pay $100 when you should have just paid a $20 copay," a former employee told Insider.

Employees began relying on the copay amount listed on their insurance cards rather than the amount provided by the tool. The billing software often failed to connect to EHRs to pull the data it needed to determine visit costs, preventing the clinic from collecting payment from a payer. Employees would ask patients to return to the clinic to pay the medical bill, Insider reported.

Walmart Health has struggled to credential physicians, which is a vital aspect of collecting payment from payers, five current and former employees told Insider. Some physicians in the clinics weren't credentialed, which meant patients couldn't use their insurance for their visits. 

Employees told Insider that patients' totals were not as advertised because the fees don't include services a clinician might consider when the patient is in the exam room, such as lab work or a flu swab. 

Employees told Insider they were supposed to inform patients of the visit costs before ordering them. However, employees allege that staff were encouraged to provide extra services to increase the cost. For example, a $25 dental exam and panoramic fee might be raised to $100 after a dentist chooses to use a more expensive CT scan.

"Our goal of providing affordable, accessible care with transparent pricing is as strong today as it was when we opened our first location two years ago," a spokesperson for Walmart told Becker's. "We continue to improve the patient experience and work to meet the needs of the community with every Walmart Health location we open — it is important to our customers, and it is important to us. We appreciate everything our associates are doing to meet the health care needs of their communities and deliver the quality, affordable care for which we are known."

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