Many patients have come to The Ohio State University Wexner Medical Center in Columbus uninsured — but left with Medicaid coverage. “Prior to 2014, our uninsured population was around 6%. Today, it’s under 2%,” says financial counseling supervisor Kylie Sokol.

In 2017, the department worked 1,676 patient accounts for Medicaid, compared to 451 that were outsourced to a vendor. In-house financial counselors obtain the needed verifications for pending Medicaid applications. “This avoids having to outsource cases to a Medicaid vendor that can easily be worked internally,” Sokol says.

Financial counselors routinely enroll all types of patients into Medicaid. This includes women and infants, trauma patients, and psychiatric patients.

“In addition to increasing our revenue and lowering our A/R, Medicaid expansion provides coverage for discharge needs,” Sokol explains. Patients no longer have to worry about obtaining durable medical equipment, prescriptions, or nursing home placements.

Financial counselors work in two groups. The pre-registration financial counselors take these steps:

  1. Screen patients prior to service for financial assistance, Medicaid, and Ohio’s Hospital Care Assurance Program (HCAP), a financial assistance program for income-eligible uninsured patients;
  2. Explain benefits to the insured patients;
  3. Inform patients of their estimated out-of-pocket responsibility prior to service.

“The patients that we preregister tend to be insured, making most of our work dealing with copays and deductibles,” Sokol reports.

Uninsured and out-of-network patients also are pre-registered. These patients often pay very high out-of-pocket costs.

“Our pre-reg team completes estimates to give the patient a close idea of their patient responsibility,” Sokol notes.

Staff found that a simple change in the way they ask for deposits greatly increases the likelihood of payment. Asking, “Would you like to pay today?” usually gets a flat “No.” Instead, staff advise patients of the requested deposit amount and ask, “Would you like to put this on your credit card today?”

“This results in a higher percentage of collections,” Sokol adds. Inpatient financial counselors perform these tasks:

  1. Screen for Medicaid programs, HCAP, and financial assistance;
  2. If patients aren’t eligible for any of these, they request deposits and set up payment plans.

“This can be more challenging, as the patients are already in a bed, receiving services,” Sokol says.

Scripting for inpatients begins with an introduction and explanation of why the employee is there.

“Perhaps insurance coverage termed during their stay, or they changed insurance plans,” Sokol offers.

If it’s determined that the inpatient is uninsured, staff go on to explain that they would like to see if the patient qualifies for assistance to help them with their bill.

“Simultaneously, we are also screening for Medicaid, or determining how much [of] a deposit to ask for,” Sokol explains. During open enrollment, or when the patients experience a qualifying event, the counselor discusses the possibility of enrolling in Affordable Care Act plans.

Most inpatients are instructed to leave wallets or purses containing insurance cards, recent paychecks, and other important documents at home. This creates an obstacle for financial counselors who want to assist patients, but have no way to verify coverage or income.

Sometimes, patients are unable to communicate due to medical conditions. “In these cases, getting family to cooperate with obtaining verifications can be time-consuming,” Sokol laments. Here are three issues financial counselors face commonly:

1. Insured patients often are shocked by their high deductibles.

“Patients think they did all the right things by purchasing insurance, only to find out they have a large patient responsibility,” Sokol says.

For these people, some basic insurance education is provided. “We have an internal document that explains their healthcare benefits,” Sokol notes.

This scripting is used: “I’m showing that with your insurance, it looks like you have a deductible of $4,000 and a maximum out-of-pocket cost of $8,000. That means you will be responsible for the first $4,000. Then, your insurance will pay at 80% for any services.”

“At this point, we listen to the patient,” Sokol says. “If they want to apply for assistance, they can. Or, we offer to put them on a payment plan.”

2. Patients expect financial assistance to cover both the hospital and physicians, but this is not always the case.

In Ohio, there is a non-Medicaid type of assistance that covers hospital services only. For this reason, hospital and physician financial assistance application processes are handled separately.

“Patients may have only been approved for one or the other. Or, one approval may have expired before the other,” Sokol says.

If the patient is a walk-in, or calls the department, staff review the accounts and explore all options. For some patients, financial assistance is available for both the hospital and physicians on their outstanding accounts. “Then, we educate the patient to the difference in the financial assistance programs in order to help them understand bills going forward,” Sokol explains.

3. Patients are confused by multiple bills.

Surgical patients often are bombarded with bills — one from the hospital for time, equipment, and supplies used in the OR; another from the surgeons on the same statement; and still another from anesthesia.

To head off dissatisfaction, financial counselors take an upfront approach about this.

“Our scripting for both pre-service and post-service includes a reminder that anytime you have services done at the hospital, you can expect more than one type of bill,” Sokol says.


  • Kylie Sokol, Supervisor, Financial Counseling, Hospital Admitting Services, The Ohio State University Wexner Medical Center, Columbus. Phone: (614) 293-1412. Email: