Asking for copays is never easy, but it is especially difficult in the ED. It is even harder if the patient is a child.

“Not everyone is successful at this task. We provide ongoing training, which includes scripting,” says Leslie Velez, manager of ED registration, admitting, financial counseling, and cashiers at Connecticut Children’s in Hartford. By performing their job well, registrars reduce worries for families — and bad debt for the hospital. “This is why the team addresses copay collection at the time of service,” Velez says. Here, some top ED collectors share their copay collection topics:

Kelly Pfalzgraf, an ED registrar at Connecticut Children’s, starts with a genuine smile, a pleasant introduction, and good eye contact. After completing a full registration, Pfalzgraf begins by saying, “You do have a co-pay today of X. How would you like to take care of that today?”

“I try to hold eye contact when I ask,” Pfalzgraf says.

The next step depends on what the family says. If the family asks, “Can you bill me?” Pfalzgraf matter-of-factly says, “We ask that you pay at the time of service.” If the family says, “I’d like to be billed,” Pfalzgraf asks, “Would you like to pay anything toward the balance today?” If the family says anything about inability to pay, Pfalzgraf asks, “Would you like information on our financial counselors?” Sometimes, families do not know what a financial counselor can offer them, so Pfalzgraf explains they can create a payment plan, or see if the family qualifies for assistance.

Pfalzgraf always checks to see the patient’s insurance card has been scanned in. If it is not in the system, she asks for the card. “While they are in their wallet, I will say, ‘While you’re in there, you also have a copay today of X,’” Pfalzgraf says.

David Ferrer, another ED registrar at Connecticut Children’s, starts off by introducing himself as an ED registrar to make his role clear to patients. In a previous job as a bank teller, Ferrer developed a habit of finding something to connect on when making conversation with customers. He does the same thing now with families in the ED.

Establishing a rapport makes it easier to ask for the copay. Ferrer does it this way: “There’s a copay due for the services rendered today of X. We understand that with the pandemic, there might be some hardships, but we are here to help. We accept cash and credit. How would you like to pay?”

One child came to the ED recently because of a rash. Ferrer saw the family’s ED copay was $250, but the child’s mother mentioned losing a job recently. “I kept this in the back of my head when asking for the copay,” Ferrer recalls.

The woman said she was sorry, but could not pay the $250. Ferrer responded, “I completely understand. We are here to help you through this.”

The parents did not believe they could pay half the copay either, but did agree to pay $25. “I offered the financial counselor’s information. The parents thanked me sincerely,” Ferrer reports.

Victoria Foster, a patient access service specialist in the ED at Nemours/Alfred I. duPont Hospital for Children, stays sensitive to people’s emotions. “I always use a very light, sympathetic tone of voice, and I have a few different ways that I ask for the copay,” Foster says.

Timing is important. Once the child is medically stable, parents are much more likely to be willing to handle the copay. “If they want to pay it, I take it. If they are not able to, I let them know that it’s not a problem, and we can bill the copay,” Foster explains.

If the amount is the issue, Foster makes it clear a partial payment is OK. It is better than billing someone for the entire copay. “If they are upset because they can’t or don’t want to take care of the payment, I let them know to contact our financial services for help,” Foster says.

For self-pay patients, Foster makes sure they are aware there is no insurance listed in the chart. This gives the family a chance to explain where they are in the process of obtaining insurance. Some say something like, “I filed for Medicaid, but am still waiting for approval.” Foster then says, “For families that have no insurance, we usually ask for a $250 deposit. Would you be able to put anything toward that today?”

“Most of the time, families do not want to pay it, but occasionally they do,” Foster notes.

For those who do not pay, Foster offers an appointment for a phone call with financial services and financial assistance brochures with contact information. “We ensure that they have the information that they need to seek assistance,” Foster says.