At Nemours/Alfred I. duPont Hospital for Children, call center reps often field questions about expensive service. Staff do their best to answer those inquiries.
“The thing we struggle with most is validating the cost of a particular procedure or service,” says Paula Jermyn, manager of family financial services.
The real reason usually is the type of health plan chosen by the caller. Staff must find a diplomatic way to point this out. “When you choose a plan with the lowest premium, you most likely have the highest out-of-pocket costs,” says Jermyn, noting that families choose health plans without fully realizing this.
The Nemours call center fields about 1,000 calls a month. Many callers want an explanation for the high cost of healthcare. “How do you explain to a family that it involves the doctor who attended to you, multiple other providers, the cost of the OR, and the nurses who took care of you?” Jermyn asks.
Select patients complain that costs are higher than the previous year. For example, a patient might have been on a plan with a $1,500 deductible and no coinsurance last year. This year, there’s a $3,000 deductible, with 20% coinsurance until the patient hits a $6,000 out-of-pocket maximum. This means a higher bill for the patient. “In the last several years, insurance plans have become more complex for everybody,” Jermyn observes. “Sometimes, it’s too complex even for us to understand.”
There are a few staffers who have called three different people at the health plan, all of whom give different answers. “So, you have insurance companies giving conflicting answers to both the parent and the provider,” Jermyn laments. “It makes things very difficult.”
At times, it takes a great deal of effort to understand the person’s bill. Because of this complexity, it takes more time to handle an issue. “We should be getting on to the next call, but it’s not that easy anymore. The family will have a lot of questions,” Jermyn reports.
The questions are not simple, either. “You have a tripod of people trying to decipher why you were charged what you were charged for your particular bill,” Jermyn says. The parent, the insurance company, and the provider all may be stumped.
When plans change, companies do not educate their employees well. Some people do not even know their deductible. “It shouldn’t be a surprise when we call. But many times, it is,” Jermyn notes.
People often say things like, “It’s the same plan I had last year.” They don’t realize that the coverage has changed — and not in their favor. Some choose not to obtain needed care. “They might second guess whether they can go forward with it,” Jermyn says.
Comments like “I need to wait just a bit to save some money” or “I need to put a little more cash in my health savings account” have become common. “Our conversations are very much soft-ask. You become a budget person to help them figure it out,” Jermyn explains.
Many people wish aloud they had paid an extra $15 a month to secure a lower deductible. Others openly admit they did not anticipate needing to actually use the insurance. There are times when families are relieved to find out they qualify for a medical grant to help with after-insurance costs.
“It’s not a contentious conversation all the time,” Jermyn says. Most people expect to pay something out of pocket, but they may need help figuring out how they can afford it.
If someone is really upset, staff fall back on this statement: “We don’t need to have this conversation now.” At times, something else is going on in the family’s life that’s complicating matters: illness, divorce, or job loss. An employee may offer to speak to a higher-up to discuss alternatives. “That gives the parent a chance to take in what we’ve talked about. On our side, we’re thinking about what we can do,” Jermyn says.
Whatever the case, staff are there to help patients make good decisions. Staff play the role of educator, advisor, collector, and a sympathetic ear. “You are having to put on a lot of different hats,” Jermyn says. “Sometimes, you’re just listening.”