EXECUTIVE SUMMARY
Patient access departments are helping self-pay patients in multiple ways.
- Patients are provided with presumptive eligibility determinations for Medicaid when appropriate.
- Counselors connect patients with primary care providers.
- Patient access helps patients to retain insurance coverage.
It’s a safe bet that patients without insurance are probably pretty worried about their financial obligations. Few expect to leave with insurance not just for that particular service, but for their healthcare needs going forward.
“In some instances, we are able to help the patient obtain health insurance coverage,” says Rebecka Sandy, CHAA, CHAM, a patient access supervisor at CoxHealth in Springfield, MO.
Ongoing Contact
All financial counselors are Certified Application Counselors with the Healthcare Insurance Marketplace. Patient access also provides presumptive eligibility determinations for Medicaid, when appropriate.
“Obtaining health insurance coverage for the patient does not stop there,” says Sandy.
If the financial counselor succeeds in obtaining health coverage for a patient, the patient is entered in the department’s follow-up program. “Contact with patients is ongoing throughout the year,” says Sandy. Counselors connect people to primary care providers and preventive services. They also help them to retain their health insurance coverage.
“Since implementing our financial clearance process and follow-up program, we have seen a decrease in our uninsured population, going from 12% to 8%,” says Sandy.
At Florida Hospital in Orlando, pre-access teams verify the patient’s insurance status and benefits, then create a price estimate.
“If we come across a scheduled procedure where the insurance is no longer active, or the patient does not have an active insurance on file, we email the account to our self-pay account specialist,” says Victor O. Odoh, pre-access manager of surgical and pre-registration operations.
The self-pay account specialist then contacts the patient to verify if they are a true self-pay patient. If the patient is indeed a true self-pay, then the patient is offered the option to apply to the hospital discount’s program.
Either way, says Odoh, “by being proactive in the self-pay process, patients are better prepared coming into their visit.”
Time Is a Challenge
ED registrars at Sharp Chula Vista Medical Center in San Diego assist uninsured patients in many ways. First, registrars ask a series of questions to determine if the patient may qualify for other insurance coverage.
“They are provided with Covered California contact information to get further insurance coverage,” says patient access manager René Rodriguez, MBA.
In-addition, patients who meet the Medi-Cal eligibility requirements are enrolled in the hospital’s presumptive eligibility program. This provides qualified individuals with immediate access to temporary, no-cost Medi-Cal services while individuals apply for permanent Medi-Cal coverage.
Although the process is very successful, it adds to the amount of time it takes to complete registration. “Therefore, it puts additional pressure on registrars during high volumes,” says Rodriguez.
- Victor O. Odoh, Pre-Access Manager, Inpatient, Surgical, and Pre-Registration Operations, Florida Hospital, Orlando. Phone: (407) 200-2359. Email: [email protected].
- René Rodriguez, MBA, Manager, Patient Access Services, Sharp Chula Vista Medical Center, San Diego, CA. Phone: (619) 502-3654. Email: [email protected].
- Rebecka Sandy, CHAA, CHAM, Supervisor, Patient Access, CoxHealth, Springfield, MO. Phone: (417) 335-7249. Email: [email protected].
