Hospitals in states that currently do not have health insurance exchanges should plan to ramp up their respective patient financial services departments with the objective of helping its patient population find and keep insurance.

One hospital in Massachusetts almost doubled its patient financial services counseling staff to help lower-income patients enroll for health insurance via exchanges, a recent case study by Healthcare Financial Management Association (HFMA) found. Boston Medical Center (BMC) after Massachusetts temporarily increased its staff when the state’s health insurance exchange came online in 2007.

“Many of these patients never had health insurance, so purchasing insurance was an entirely new concept,” Deed McCollum, patient financial services manager at BMC, told HFMA. “They didn’t know they had to select a health plan and pay premiums, and they didn’t pay attention to the letters with instructions about determining their insurance eligibility. These patients will come out of coverage again and again if you don’t educate them about the process and their responsibilities.”

Many patients may find navigating online health exchanges a challenge. According to Richard Silveria, BMC’s senior vice president and CFO,  many lower-income patients “either don’t have web access or they don’t do much web commerce, so it’s not always intuitive to them.”

To help its patient base, BMC increase its PFS counselors from 11 to 21 and trained them on how to approach uninsured patients and help them through the insurance purchasing process.

“As an increasing number of patients gained coverage and learned to handle the responsibilities that come with insurance, the need for the additional counselors lessened,” according to the HFMA article. “After about two years, BMC started reducing the size of its financial counseling staff through attrition. Today, the medical center employs 11 counselors, the same number it had before the health insurance marketplace was established.”

While BMC believes that getting its patients covered by insurance will help, it is not a solution to bad debt. Low-income patients usually purchase plans with high deductibles and co-payments. “The out-of-pocket costs are a challenge to folks,” Silveria told HFMA. “As you put more out-of-pocket costs on people who are at the lower end of the pay scale, they have to make some decisions on what bills they pay, and that just puts more credit risk on providers.”


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