At Michigan-based Spectrum Health, many patients are reporting losing health insurance because of job loss.

“Our next question is, ‘Are you eligible for COBRA?’” says Elisa Contreras, manager of financial counseling. Many patients are, but they cannot afford it. The hospital offers to cover premiums for up to six months.

This is just one way staff can help newly uninsured people. “We wear many hats in financial counseling. We follow the patient from the front end to the back end,” Contreras says.

The registration system includes a financial assistance module that flags all underinsured or self-pay accounts. “We have 44 financial counselors trained to work those cases. We call the patient prior to services,” Contreras reports.

Sometimes, it turns out the “uninsured” patient actually has insurance after all. “If we see that the patient did have Medicaid or commercial insurance, we go in, attach the insurance to the account, and send it out,” Contreras says.

If the patient truly is uninsured, these steps are taken:

  • Staff screen the patient for Medicaid eligibility. About one-third turn out to be eligible. This is ideal, says Contreras, since it means people can receive covered care in the future.
  • If the patient does not qualify for Medicaid, staff screen for financial assistance through the hospital. Incomes up to 250% of the Federal Poverty Level qualify for some type of help.
  • If the patient really does not qualify for any financial assistance, staff screen some more. This time, they look for possible discounted premiums available through the insurance marketplace.

About 60% of patients qualify for something. “Even if people have good coverage, we ask, ‘Is there anything we can do for you?’” Contreras says.

Patients are glad someone asks. Many with high out-of-pocket costs are happy to learn they do qualify for financial assistance. If any assistance or discounts are applied, the account is flagged immediately so there is no confusion about the amount owed going forward.

If all else fails, staff can offer zero-interest payment plans. Some accounts do end up going to collection, which no one wants. However, before reaching that extreme, there is one more possibility.

“We have a self-pay department on the back end who does a second check on the patients,” Contreras says. Patients are offered a payment plan again as a way to settle the account and avoid the collection process.

For financial counselors to keep track of all these options, top-notch skills are needed. Their knowledge level of insurance is assessed every 90 days. Ten accounts are audited every month to be sure all the right information was gathered. “Our expectations are high. We want to see that they are really telling the story of the patient’s situation,” Contreras explains.

Recently, financial counselors expanded their role even more by reaching out to the community. Their goal was to find people who were avoiding seeking needed care because of inability to afford it, undocumented status, or language barriers. Financial counselors took on all three obstacles. They spread word out via radio advertisements and social media.

The main message was, “Don’t be afraid to come because you cannot afford care.”

“We talked to the community in their native language and encouraged them to call our toll-free financial counseling line,” Contreras says.

Four thousand people called. “The phones were off the hook, and that was our intent,” Contreras notes.

Almost all the callers were eligible for Medicaid or some type of assistance. “Our No. 1 goal is to help patients with coverage for the long term, not just for the date of service,” Contreras says.