Give better answers to toughest questions

Patients need complex information on coverage

Executive Summary

Patient access employees are fielding more questions from patients about their insurance coverage. These changes were made at the University of California — Los Angeles Health System:

  • Follow-up calls are made to the payer if necessary.
  • Patient Financial Services was designated as the go-to area.
  • Financial counselors follow up with patients as needed.

Every day, patient access staff at University of California — Los Angeles Health System receive many inquiries from patients or family members that do not understand how their insurance works — Medicare, Medicaid, and commercial insurances alike, reports insurance verification manager Jose Angel Torres.

"A large majority of patients do not understand their own benefits," he says. "The big question on everyone's mind is 'How much will I have to pay out of pocket?'"

Patients are confused about copays, deductibles, co-insurances, out-of-pocket maximums, calendar or lifetime maximums and how these apply to the type of visit, procedure, or hospitalization someone is having, says Torres. "One can empathize with a layperson trying to understand the complexities of our insurance system," he says. Here are changes made by the department to help patients with questions about their coverage:

• Entry-level registrars, who aren't as well-versed in insurance coverage, direct patients to the correct area for assistance.

Whenever in doubt, staff members are asked to defer to their supervisors or managers. "Whenever our management team is in doubt, we reach out to our billing office, our contracting office, or have a follow-up call to the patient's insurance company," says Torres.

• One office within the health system, which is Patient Financial Services, is designated as the go-to area for questions about insurance and benefits.

"Our physicians' offices also refer calls to this group to answer questions," says Torres. "Sometimes an inquiry might require follow up."

In this case, the financial counselor takes the patient's name and contact number and reaches out to the appropriate areas such as the insurance company, billing, or contracting, and the counselor finds the correct answer.

• When there are concerns or discrepancies, a three-way conversation with an insurance company representative is held.

A patient might not be aware of the correct insurance terminology, so it helps to have an access staff member act as a liaison. "For those patients that are more informed, we can refer them to their payers. But many patients will appreciate the extra assistance," says Torres.

At Gundersen Lutheran Health System in La Crosse, WI, patient access employees give patients a card called "Answering your Billing Questions." "It has our department telephone numbers to call when the patient has questions," says Barb Ramsey, manager of patient services.

Patients are directed to financial counselors when they aren't able to pay for their services that day, if they have questions about their bills, or if they need to change their coverage in order to come to the organization.

"We have financial counselors out on our floors, who are available to come directly to any department," says Ramsey.

SOURCES

Barb Ramsey, Manager, Patient Services, Gundersen Lutheran Health System, La Crosse, WI. Phone: (800) 362-9567 ext. 55602. Email: baramsey@gundersenhealth.org.

Jose Angel Torres, Manager, Insurance Verification, University of California — Los Angeles Health System. Phone: (310) 267-6628. Email: JATorres@mednet.ucla.edu.