Got an angry patient on your hands? Take these steps
Don't be the bad guy
Patient access staff often unwillingly play the part of the "bad guy" when they attempt to collect money from someone who has just lost his or her benefits or is blindsided with a huge bill.
These days, a whole host of scenarios could result in a patient or family member becoming very angry at an access staff person, says Cheri S. Kane, MSA, FHFMA, CHFP, FACMPE, division president of The Outsource Group in St. Louis. Kane also is former vice president of revenue cycle at Grady Memorial Hospital in Atlanta.
"First, patients don't understand what their insurance coverage is. They arrive at the hospital to find that they have a high deductible of $1,000 to $2,500," says Kane. "Some hospitals won't treat patients for elective services without those dollars being paid up front."
A patient may arrive at the hospital for what he or she believes is a short outpatient surgery, only to find out the bill is estimated to be more than $10,000 for just a one-night stay.
"We teach our patient access representatives to be understanding and empathetic with the patients," says Kane. "The patients are not well and are under emotional strain with the financial implications."
If a family is not aware of the estimated liability of a procedure or admission until the day of service, it can be very stressful for everyone involved. "Much insurance coverage has high deductibles, which results in patients being unprepared for the upfront liability when faced with a medical need," says Tina Williams, director of access services at Monroe Carell Jr. Children's Hospital at Vanderbilt in Nashville, TN.
If a patient presents with new insurance for an elective procedure or admission at the time of arrival, which was unknown at the time of scheduling or verification, this can cause a delay. In turn, this creates more frustration for the patient.
"Most patients are not aware of the requirements that their insurance company has for elective procedures. They do not understand the work involved in verifying benefits and precertification," says Williams. "What every patient does understand is that they want the insurance company to pay as much as possible to lower their out-of-pocket liability."
At Monroe Carell Jr., the insurance management department provides upfront liability information to families who are coming in for elective operative procedures or admissions several days in advance.
"The patient access staff then collect the amount that insurance management loads in the system. This cuts down on the surprises on the day of the procedure," says Williams. If insurance management is unable to reach the family first, access staff are trained on how to approach and work with patients directly. This includes assisting patients with several options for financial assistance if they are either uninsured or underinsured.
If the situation warrants, all staff are able to hand out $5 vouchers, redeemable at the gift shop or the cafeteria. "These can go a long way in a situation where frustration is high," says Williams. "Access staff are trained to listen to the patient, empathize, acknowledge the concern, respond in a calm manner, and thank them for voicing their concerns. Staff are also taught to get a manager involved, as soon as they feel their efforts of resolution are not working."
One approach that access staff use is a simple, straightforward explanation. Patients are told that the hospital wants their insurance to pay as much of the liability as possible. For this reason, staff explain, it's important for them to verify benefits, ensure pre-certifications are in place if applicable, and avoid any other issue that could cause the insurance company to deny the claim. "This information usually defuses the situation, once it is explained," says Williams.
Access staff must be patient, understanding and empathetic, but at the same time, holding to the hospital's credit and collection policy, says Kane. If a patient has an angry outburst, Kane recommends that access employees take these three steps:
Bring that individual to a quiet room away from other patients.
Ask the patient to sit down and relax so that you can address the problem.
Request that someone come and assist you with the patient. "If necessary, the first person may need to leave. The replacement handles the situation," says Kane.
[For more information, contact:
- Tina Williams, Director of Access Services, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Nashville, TN 37232. Phone: (615) 322-0408. E-mail: [email protected].]
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