Patient not honest? Coverage unlikely

Some might withhold information

“Get out of my room! I’m not signing any paperwork. How you get paid is your problem, not mine.” That’s what a self-pay patient who required open heart surgery told a case manager at Trinity Rock Island (IL).

The employee was unable to determine if the patient was eligible for some type of assistance, because she refused to provide any information. The next day, Linaka Kain, the hospital’s disability examiner and Medicaid specialist, turned things around with a direct approach.

“I told her, ‘I want you to understand that this illness is chronic, and you will need follow-up care with specialists. How do you see yourself obtaining these things if doctors in private practice are not going to see you because you have no money?” says Kain.

Kain stated that her goal was to get the patient coverage, which would allow her to get the care she needed, not just right now at the hospital, but elsewhere as well. “I asked her to think about that, and then call me if she decided she wanted my help,” she says. A few minutes later, the patient asked Kain to return. After learning that the woman was appealing a denial for Social Security Disability, Kain was able to provide her with documentation to assist in her appeal.

More information

Job history, the fact that the patient declined employer-provided coverage, lack of a permanent address, or the details of temporary living arrangements are important factors that can determine how a patient can obtain coverage.

“Getting more information from the get-go enables you to tell where the patient is going to fall in terms of various kinds of programs,” says Kain.

To get patients to be more forthcoming with information, Kain chooses her words carefully, using these practices:

• Kain doesn’t tell them her actual job title.

If patients hear the words “disability examiner” or “Medicaid specialist,” they might tune out right away. “They will say, ‘Well, I’m not disabled,” or “I’m not eligible for Medicaid.’ Even if you say, ‘I’m a financial counselor,’ they think you are there to collect money, and they become defensive,” she says.

Instead, Kain identifies herself as a “benefits administrator,” which helps patients to understand that she’s there to see if they’re possibly eligible for some type of assistance program.

• The first thing Kain says is, “I’m here to help you.”

“That breaks the ice right away,” she says. “If you take that approach, they are more apt to give you the information that you are trying to obtain.”

• Kain avoids mentioning payment plans in the beginning of the conversation.

“You don’t want to seem like you are putting your hand out to get some type of payment,” she says. However, if the patient appears uncooperative, Kain doesn’t hesitate to ask how they plan to pay their out-of-pocket costs. “You can usually tell by their answer if they will be able to do a payment plan or if it’s totally out of the question,” says Kain.

• Kain tries to get a whole picture of the patient’s situation, including clinical concerns.

If she learns a patient has a chronic or long-term condition, she uses this information to underscore why it’s so important the patient needs to cooperate. “That opens the door to me saying, ‘Even the assistance program we offer isn’t going to take care of all your bills. You will need some type of insurance,’” she says.

• Kain generally waits to meet with patients only after they’re on the floor.

When patients are in the intensive care unit, they are typically very sick and not as coherent or willing to talk, she says. “By waiting until they get up on the floor, it makes patients feel you are not thinking about money first and them second.”

• Kain asks if the patient is receiving any other kinds of assistance.

“If you find out the patient is on food stamps, for example, you know they have already been screened as being below 200% of the [Federal Poverty Level],” says Kain. “This way, you are not duplicating efforts.”