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Patient’s coverage inactive? Say this
Registrars in a position to help
A patient recently registered at Denver-based Porter Adventist Hospital had just lost his job and employer-sponsored insurance, and he was under the mistaken impression that COBRA coverage was automatic.
“I didn’t know that was the issue. All I knew is he was showing as a self-pay patient,” says patient access representative Tammy Sammon. “I explained that I didn’t see that he had any insurance at that time.”
The man quickly became angry, and Sammon arranged for one of the department’s health benefit advisors to meet with him. “He found out that he needed to call COBRA to get his insurance going,” she says. “He did have to change some things around so that he would be covered. But he was appreciative that we took the time to figure out his situation.”
An insurance eligibility tool can instantly tell registrars if a patient’s coverage is valid, but it can just as quickly put them in an awkward position. Jennifer White, director of patient access at Cottage Hospital in Woodsville, NH, says, “It can be a difficult conversation when the insurance returns inactive.”
Cottage Hospital’s registrars take these steps:
• The registrar says to the patient, “The insurance information we processed is coming back inactive. Do you have an updated card?”
• If the insurance is actually inactive, staff assure the patient it won’t have any effect on the care he or she receives.
• Staff members discuss other options, including internal charity care, payment plans, and external benefits.
Patients are appreciative of the assistance when resolving issues with coordination of benefits, especially when they didn’t realize there was any problem with their coverage, White reports. “We have some state insurances that require patients to make monthly payments contributions to his or her plan,” she says. “Life gets busy. Sometimes, a payment is missed or forgotten, which in turns becomes inactive for the time of service.”
When this situation happens, staff can give the patient the information so they can make the payment or contact the insurance company to verify that payment was received, White says.
Carole L. Sraver, director of patient access at Washington Adventist Hospital in Takoma Park, MD, says registrars typically get in touch with the patients before they arrive for their procedures or treatments to explain the findings and ask “Have you recently switched insurances?”
Patients might have chosen a different insurance plan through their job and forget that they will receive a new card with a different plan number. “This will result in the system telling us the patient’s benefits are inactive,” says Sraver. “One of our questions will typically prompt the patient to tell us something they had forgot to mention.”
Sammon notes that a patient’s coverage might be inactive due to non-payment of premiums, a job change or loss, or a waiting period to qualify for Medicaid.
“No matter what the situation is, it is always hard to tell the patient that their insurance currently is showing inactive,” she says. “I try to be very empathic and remain very calm when telling them this.”
Sammon first verifies all the information. If everything is showing as correctly entered, she offers the patient the chance to speak to a health benefit advisor to learn about possible options.
“They may qualify for charity, or they may be able to put a small amount down and the set up payment arrangements,” says Sammon. “Most of the time, the patients feel that you listened to their side, and the hospital still gets some type of payment.”
For more information about inactive insurance benefits, contact:
• Tammy Sammon, Patient Access Representative, Porter Adventist Hospital, Denver. Phone: (303) 778-5810.
• Carole L. Sraver, Director of Patient Access, Washington Adventist Hospital, Takoma Park, MD. Phone: (301) 891-5185. Fax: (301) 891-5407. Email: firstname.lastname@example.org.
• Jennifer White, Director of Patient Access, Cottage Hospital, Woodsville, NH. Phone: (603) 747-9252. Fax: (603) 747-9342. Email: email@example.com.