Normally, financial counseling at UnityPoint Health’s hospitals is handled face to face and by appointment.

“We are now having to do it by phone, FaceTime, or mail. We have to shift gears and meet the needs of the patients,” says Linaka Kain, DE, regional manager of patient financial coordinators and the marketplace exchange.

Financial coordinators continue working onsite. “We will probably be one of the last groups to work from home, besides registration,” Kain predicts.

One obstacle to at-home work is that some financial counselors lack laptops or wi-fi. “People don’t think about that until something like this happens. Then, everybody scrambles,” Kain observes.

The department is now thinking ahead. “If something like this happens down the road, we could have a team of multiple financial counselors working from home, with one person working in-hospital,” Kain offers.

For now, counselors are filling out paper applications, mailing these (with postage-paid envelopes) to patients to sign, then entering the information into the portal. “It’s almost going backward,” Kain notes. “Back in the day, when everything was done by mail — now we’re back to doing that.”

Some patients want to complete the applications over the phone but want personalized help. They ask financial coordinators to FaceTime them. “People are out there during this crisis and need help,” Kain says. “If it means FaceTiming with patients, sometimes that’s what you have to do.”

The department has seen an increase of about 20% in uninsured since the federal tax penalty for not being enrolled in health insurance was removed in 2019. “A lot more people have not gotten coverage in the last year. Consumers and patients think it’s thousands of dollars a month to get a plan because of what they hear on the news,” Kain says.

Financial counselors let them know there are less expensive options. “The [Affordable Care Act] marketplace has a lot of no-premium plans,” Kain says. “There are plans with $5 premiums that were even better than many large employer plans.”

The self-pay population has increased since the dawn of COVID-19, too. “People are in a panic, and everybody wants to be seen and tested. We are seeing a bigger influx of self-pay,” Kain reports. About 25% of this group is converted from self-pay to Medicaid coverage.

The underinsured patient population also is growing. The department is seeing many more people with high deductibles and large out-of-pocket costs. Many of these people have Medicare, but do not qualify for Medicaid as secondary insurance, which carries the same benefits as traditional Medicaid. “That group is significantly higher than I’ve ever seen,” Kain adds.