“What do you mean, my insurance is inactive?”
While rounding in check-in areas, this statement was overheard by ambulatory support leadership at Ann & Robert H. Lurie Children’s Hospital of Chicago. The problem was recent changes to the state’s Medicaid program, which switched all families on Illinois Medicaid to Medicaid managed care plans.
“The change is very frustrating for our families. They are not happy to hear the news,” says Zander Davis-Washington, director of ambulatory support.
Some visits, such as labs and ancillary services, now require referrals. Some plans are no longer in network with the hospital. “That was a big change with our families,” Davis-Washington says. “Previously, they never had to manage their insurance. They just showed up with a card.”
Patient access leaders saw that staff were unsure of what to tell frustrated, confused families. “We got together as an organization and quickly formulated a plan on how to respond to this,” says Davis-Washington.
Immediate response
A Rapid Response Team now addresses Medicaid managed care situations as soon as they occur. “This team consists of subject matter experts on insurance, with in-depth knowledge of how the state is operationalizing this initiative,” says Davis-Washington.
Patient access managers were given dedicated pagers so employees can alert them of a problem with a Medicaid managed care plan. “Every day at 4 p.m., we have a conference call to discuss how these issues were resolved,” says Davis-Washington.
Patient access employees educate families on their new plan’s requirements. “If needed, families are assisted in contacting central registration to change their coverage and make sure it’s effective and in network,” says Davis-Washington.
If the plan is not in network, staff inform families that if the plan was auto-assigned by the state, they have 90 days to request a different plan. “A mom can call an 800 number and say, ‘I go to Lurie Children’s, and this insurance is not in network for them,’ and the representative can guide the family to what insurance plan would work best for them,” says Davis-Washington.
Many times, the family’s coverage is successfully changed to a plan that is in network. “Families end up seeing us as their advocate,” says Davis-Washington. “Staff are now confident in addressing this issue.”
