A scheduler might tell a patient his or her insurance will be billed — with no mention of the patient’s potential out-of-pocket costs. Weeks later, a registrar says a deposit of at least $100 needs to be paid in advance. Months later, a surprise bill for $1,000 arrives. Inconsistent messages about money result in angry patients.
“When visiting the hospital, billing is different for each encounter,” says Meghan Duhamel, CHAA, patient access associate at Connecticut Children’s. “The insurance coverage varies by not only the carrier, but also by the type of plan — high-deductible, HMO, PPO, or POS.”
There are so many other variables the insurance company considers when deciding which types of services to cover. Type of service, whether the service included general anesthesia, or whether there was a contrast study are just a few factors. “The cost may be different each and every time if the doctor’s order varies just a little bit,” Duhamel explains.
Families struggle to comprehend why they are paying so much when they arrive for a diagnostic study. “We as patient access staff do our best to inform the families ahead of their arrival,” Duhamel says.
Staff offer a 10% prompt pay discount, payment plans, and use scripting. “This way, they will know what to expect each and every time they call to schedule or arrive for an appointment,” Duhamel says.
“When in doubt, find it out. Don’t make up answers or guess.” That is the motto for Patient Access Associate Abbey Fontana, CHAA. Not knowing the answer is not the problem.
“Providing the incorrect answer is the problem,” says Fontana, who works with Duhamel at Connecticut Children’s.
Giving families a point of contact for each area of the revenue cycle is the best way to provide a consistent message. When patients call in for an explanation of their bills, they are connected with customer relations. If they need to set up a payment plan, financial counselors are brought in. “To make sure there is no confusion, I go right to the source,” Fontana says.
A consistent message prevents confusion. Richard Berezowsky, CHAA, a central scheduler in patient access at Connecticut Children’s, sees this situation daily: A family calls scheduling to make an appointment. After the registration is completed, and their insurance is verified, the family asks questions about their specific coverage.
The scheduler does not try to answer the questions, instead telling the family: “While your insurance is accepted at our facility, the actual coverage varies from plan to plan. You should contact your insurance provider to ensure coverage of this particular visit.”
Staff direct the family to the financial department for any further questions or assistance. Schedulers are clear that they are not the appropriate team member to speak with regarding their specific coverage. “This limits what is said to the family by the scheduler, reducing the chances of giving incorrect or incomplete information,” Berezowsky notes.
Both the language used and the tone are critical. “Families do not want an automatic response or robotic message,” Berezowsky observes. “They don’t want to feel their time is being wasted.”