Certain patients present with valid insurance cards, but what they do not realize is their health plan covers next to nothing. At Phoenix-based Banner Health, this happens often with ED patients. “We are seeing a large number of employers that are offering this sort of limited benefit plan as their employee coverage,” says Amber Hermosillo, revenue cycle education and quality director.
Some patients chose a limited benefit plan without realizing it would only cover a certain dollar amount. “Patient access can see these plans coming,” Hermosillo says. “The cards are often overloaded with all the different ‘network’ logos the plan is partnering with.”
Unlike other health plans, those with limited benefits are difficult to obtain electronically. “Some health plans cover a very low dollar amount per visit or per day,” Hermosillo reports.
This leaves patients stuck with the rest of the hospital bill. Banner Health’s patient access staff are seeing many more patients in this tough situation. “We knew we had to find a way to assist our underinsured patients in the same regard as an uninsured patient,” Hermosillo says.
The revenue cycle department worked with vendors to offer these patients two new financing options: In-house payment plans (some interest-free) and a Banner Health-branded credit card. “We give an already-stressed out patient more time to pay,” Hermosillo says.
At Huntsman Cancer Institute in Salt Lake City, more patients are arriving with short-term health insurance. Most plans cover little or nothing. “Oftentimes, patients do not know what they sign up for,” says Junko I. Fowles, CHAM, CRCP-I, supervisor of patient access and financial counseling. The patients end up receiving a bill for almost all the costs.
The root of the problem is many people still choose lower-premium plans with poor coverage. Every day, self-pay direct admissions come in with unexpected illness or injury. “Patients end up with enormous medical bills,” Fowles notes.
Many do not qualify for charity care because their income is too high, or because they have too much savings. Even if they do qualify, charity only covers charges included in the bills. The patient still has to worry about how to pay for prescriptions, durable medical equipment, or care at skilled nursing facilities.
A few patients are eligible for Medicaid or COBRA (if it is within 60 days of the loss of employment and the patient was insured previously under an employer-based plan). Otherwise, says Fowles, “there really aren’t many options. Some patients resort to crowdfunding.”
One uninsured patient missed the annual enrollment deadline, but called an insurance agent and purchased a plan anyway. “It turned out it was one of the bridge gap policies,” Fowles recalls. The plan would have paid $500 of the billed charges had it not been for the pre-existing condition. The plan ended up paying nothing.
As a regional referral facility, Huntsman sees dozens of plan issues in different states and regions. Clinic intake coordinators and schedulers watch for plans with limited coverage so patients can be warned at referral. “If a patient is referred for high-dollar treatments or is directly admitted to the inpatient unit, our patient financial advocates intervene,” Fowles explains.
The patient is screened for Medicaid eligibility, payment plans, financial assistance, or the ability to enroll in a plan that offers comprehensive medical coverage. “This population is likely to require ongoing high-dollar treatments. Early intervention is the key,” Fowles adds.