Ambulatory Care Quarterly

Patients want registrars to educate them

Many uninformed about coverage

More often, registrars are finding themselves in the difficult position of educating patients about their insurance coverage, according to Steph Collins, manager of patient access at Fairview Northland Health Services in Princeton, MN.

"We are definitely finding it necessary to help patients understand their insurance plans," says Collins. "Some patients are surprised to learn they have a deductible and co-insurance."

Many plans are changing now from a co-pay to a deductible or co-insurance plan, says Collins, and registrars find themselves explaining what that change means to the patient. For example, she says, a patient might present to the emergency department and find out after speaking with registrars that they have a large deductible, when they thought they had a co-pay only. "Some patients just do not understand what a deductible is or what it means to them," says Collins.

As a service to patients with scheduled services, registrars are informing them of their potential out-of-pocket expenses, says Collins. "Some people are shocked, because they didn't realize they had a deductible or co-insurance," she says. "A few patients choose to cancel or seek alternative services with their provider that is at a lower cost for them at the moment."

Calm under pressure

"The best thing to do with patients who are upset or concerned about their coverage or out-of-pocket expenses is to explain as best we can what their coverage means to them," says Collins.

At Virginia Mason Medical Center in Seattle, staff members answer questions for patients about their insurance, to a certain degree, says Angela Cabarteja, supervisor in patient financial services. "You do have to be careful not to go too in-depth, because each plan can vary so much," she says.

Staff members often explain how much the deductible, co-insurance, and out-of-pocket maximums are, and how much the insurance shows has been met so far, says Cabarteja. "The patient usually just wants to know how much they will be responsible to pay out of their own pocket," she adds.

When a patient becomes upset or frustrated, says Cabarteja, staff work hard to remain calm and understanding. "Insurance can be very confusing, even when you are in this line of work and deal with it every day," she adds.

Staff members might be able to think of another way to explain a particularly confusing point or ask if a caller would like to come in to review the information in person, she says. If staff aren't able to answer specific details about a person's coverage, they'll offer to have someone from the insurance company call to discuss it, says Cabarteja.

"Unfortunately, there are times when you do have to refer them back to their insurance company for more specific details," she says.

Sources

For more information on educating patients about their insurance coverage, contact:

  • Angela Cabarteja, Patient Financial Services, Virginia Mason Medical Center, Seattle. E-mail: Angela.Cabarteja@vmmc.org.
  • Steph Collins, Manager of Patient Access, Fairview Northland Health Services, Princeton, MN. Phone: (763) 389-6263. Fax: (763) 389-6446. E-mail: scollin1@fairview.org.
  • Todd Shoaf, Director of Patient Accounting, Moses Cone Health System, Greensboro, NC. Phone: (336) 832-8014. Fax: (336) 832-8583. E-mail: Todd.Shoaf@mosescone.com.