EXECUTIVE SUMMARY

Patient access leaders at Unity Point Health System — Rock Island increased revenue by $4.8 million by identifying current coverage and obtaining Medicaid coverage for self-pay patients. Some patients deny having coverage in a misguided attempt to obtain charity assistance. Others are unaware of existing coverage. Patient access can:

  • alert providers’ offices if patients are uninsured;
  • ensure post-surgical patients have coverage for prescriptions and follow-up care.
  • reschedule elective procedures until patients obtain coverage.

If a patient clearly states that he or she has no health coverage, it might seem a waste of time to run a thorough insurance eligibility check. However, registrars at Unity Point Health System — Rock Island (IL) do this check for every self-pay patient, with surprising results.

“We often find they do have some kind of insurance,” explains Linaka Kain, manager of the Marketplace Exchange/disability examiner. “We’ve had patients who’ve had coverage for years and don’t even know that they’ve had it.” This insurance eligibility check is one reason for a dramatic increase in revenue achieved by the department. “We were able to increase revenue for our self-pay population by $4.8 million” in one year, reports Kain.

Some patients mistakenly discard important insurance information. “We get that all time,” says Kain. “They see something from [the Department of Human Services] or the hospital, think it’s a bill, and just throw it away. Little do they know that it’s an insurance card.”

A small group of patients wrongly assume they will get free care if they deny having coverage.

“What they don’t realize is that we are going to find out anyway,” says Kain. “Before the [Affordable Care Act], many people got their bills written off if they met criteria for charity care. It’s not that way anymore.”

Charity assistance is primarily for the indigent population and is the “payer of last resort,” underscores Kain.

“Everybody has guidelines to follow. Most of the people who were on it are eligible for coverage now.”

Many qualify for coverage

At University of California — Los Angeles (UCLA) Health System, about 95% of self-pay patients qualify for Medi-Cal (California’s Medicaid program).

“When self-pay patients present, we first try to secure a deposit; then we do a high-level financial screening,” says Helen Contreraz, director of patient access. “Right now, we are focusing on our inpatient population because the dollar amount is much higher.”

Some patients purchased coverage on the Health Insurance Marketplace but stopped paying their premiums because they lost their jobs. These patients often are surprised to learn they qualify for Medi-Cal coverage. Cris De Castro, CCS, manager of financial counseling for patient access services, says, “We make sure they have coverage from the last day their Exchange plan was active.”

UCLA Health System’s patient access department began offering financing to patients in December 2014 by arranging a loan on favorable terms for patients with a third-party bank. Contreraz says, “Deductibles are quite high. Many patients need a year or 18 months to pay them off.”

“Bronze” plans purchased on the Health Insurance Marketplace in 2015 have an average deductible of $5,181 for individuals, up from $5,081 in 2014, according to a report from HealthPocket, which publishes health insurance market analyses.

Patient access determines if the patients qualify for a loan based on their credit score and ability to pay. Castro says, “We’ve been successful in getting people prequalified for loans to pay off high deductibles, at terms that the patients need.” (See related stories in this issue on building a trusting relationship with patients and success with presumptive eligibility.)