Was Coverage Lost Due to Illness? Patient Access Can Help
Financial navigation stops lost revenue
EXECUTIVE SUMMARY
A financial navigation program for hematology and oncology patients ensures ongoing coverage, even if patients become unemployed due to their medical condition. Patient access:
- meets with patients right after their initial consultation with the physician;
- obtains Medicaid coverage for the patient, if possible;
- screens patients for charity care before accounts go to collections or bad debt.
Recently, a patient receiving infusion treatments at Nyack (NY) Hospital lost coverage in the middle of the year — and in the middle of his treatment. The patient had lost his job because of his medical condition.
Due to a novel financial navigation program for hematology and oncology patients, the man was able to obtain ongoing coverage and continue treatment as planned.
“We confirmed the patient would have Medicaid coverage to minimize the coverage gap period,” says Patient Access Manager Jason Guardado.
No Lapses in Care
The patient started treatment when insured by a commercial plan through his employer.
“Mid-year, we were alerted by the patient of their discontinuance of employment due to their medical condition,” Guardado explains.
Patient access immediately began a Medicaid eligibility application through the New York State of Health Marketplace.
“We were able to acquire Medicaid coverage,” Guardado notes. “In addition, we simultaneously screened the patient for charity care.”
One of the patient’s cycles of treatment fell within a period prior to the approval of the Medicaid.
“We conducted a charity care screening as a back measure for any unforeseen gap coverages or out-of-pocket patient expenses as a result of non-covered services,” Guardado says. Charity care assistance was provided before the account went to collections or bad debt status. This allowed the patient to continue as planned with the treatment plan. There were no lapses in any infusion services, other medical procedures, or ancillary services at the hospital.
“Throughout all this, we kept in constant contact with the patient,” Guardado recalls.
Patient access employees gave ongoing status reports so the patient would not have to worry about the cost of treatment.
“We ensured that the financial burden did not impact the patient’s level of care or quality of life,” Guardado says.
Very Early Discussions
Patients meet with the clinical team and financial clearance team the day after their diagnosis and initial consult with the physician.
“We conduct a ‘New Patient Orientation Day,’” Guardado notes. “All the interdisciplinary teams meet with the patient on the same day for face-to-face introductions.”
Patients learn about all the components involved in their care: clinical, nutritional, pharmaceutical, social work, and financial.
“We have a patient-focused conversation, providing the patient with an overview of our role in their financial navigation during their treatment,” Guardado says.
The emphasis is always on the patient’s well-being.
“We assure the patient we are taking on their financial burden, so they can solely concentrate on their clinical care,” Guardado adds.
This means quickly responding to any financial-related concerns the patient might have in the future. “We ensure there is continued financial support, regardless of changes to insurance or life events,” Guardado says.
Financial Clearance Specialists
Financial clearance specialists even make themselves available in person during the patient’s infusion visits or other hospital visits.
“Some patients come to our office on the day of their medical visits,” Guardado says. “They can walk in without scheduling an appointment.”
When necessary, financial clearance specialists work with a local program for cancer patients. “We may be able to obtain additional financial assistance when we are unable to do any more on our end,” Guardado notes.
A growing body of research suggests that financial burden negatively affects quality of life for cancer patients.1 The financial navigators’ goal is to minimize this burden so patients can focus on their clinical well-being.
“We want to provide a patient experience that is inclusive of exemplary financial education and assistance, as well as exemplary clinical care,” Guardado says.
REFERENCE
- Kale HP, Carroll NV. Self-reported financial burden of cancer care and its effect on physical and mental health-related quality of life among US cancer survivors. Cancer 2016;122:283-289.
SOURCE
- Jason Guardado, Manager, Patient Access, Nyack (NY) Hospital. Phone: (845) 348-2316. Email: [email protected].
A financial navigation program for hematology and oncology patients ensures ongoing coverage, even if patients become unemployed due to their medical condition.
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