Children's Hospitals Today - Winter 2023 - 22

FEATURE / FINANCIAL STABILITY
qualify for GAP. Now instead of bank statements, proof of
income and a year of financial history, all that's needed is a
W-2 from the prior year. Even then, if a family doesn't have
access to a W-2, the self-pay team will walk through a different
application with them. " Because of this, we started
to see the applications for the program increase, which
was exciting, but we realized there was an influx of questions
about insurance we weren't equipped to answer, " says
Ashley Karlen, director of revenue cycle management at
Gillette Children's.
" IT'S IMPORTANT TO UNDERSTAND
WHAT ILLNESS, AN INJURY, A
BIRTH DEFECT OR A CHRONIC
CONDITION CAN DO TO A FAMILYʼS
FINANCIAL SITUATION. "
The organizations' programs didn't account for the confusion
many patients had regarding their billing, insurance
and payment requirements. There was an existing financial
screening question in place during the new patient and scheduling
process to account for any concerns a family may have
with their ability to pay. But over time, the team at Gillette
Children's learned that patients and families need specific
insight into how their individual insurance plans work with
the care they're receiving and how services that could result
in surprise billing might affect their ability to pay.
To address this, a new financial advocacy team was created.
This is not a team with dedicated work queues, or a
call center focused on processing issues as quickly as possible.
Instead, the team of advocates is a dedicated resource
for parents and families to use when they need support or
have financial questions or concerns-whether it's a threeminute
or three-hour conversation. Additionally, whenever
a patient has a scheduled appointment that could result in
unplanned costs, an advocate calls to review their insurance
plan and walks the family through every scenario so there's
no surprise billing on the back end. Examples of this might
be a cranial cap for infants or prosthetic fitting-because
insurance plans have started to consider them a " benefit
exclusion, " Gillette Children's billing system prompts the
financial advocacy team to reach out and assist the family.
" We've learned to start setting up three-way calls with the
family and the insurance company because the insurance
rep will tell us one thing and the family will tell us another, "
says Karlen. " This team is really beneficial and makes sure
everybody's on the same page. "
The advocates do most of the heavy lifting with insurance
to reduce the burden on patient families. " We exhaust every
possible effort on our end to make sure that something's going
to be covered with the family. We already know these
families are dealing with a sick child, with complex medical
conditions, and we don't want insurance to be another
stressor for them, " says Karlen. " We are definitely willing to
fight that good fight for them. "
Most recently, Gillette Children's launched a presumptive
assistance program. Throughout 2020 and 2021, GAP
remained stagnant despite an economic downturn. " There
was a population we believed qualified who weren't applying
for GAP and instead were just paying their bills, " says Karlen.
" Whether it's because of stigma around receiving assistance
or something else. "
The program uses the guarantor's information to automatically
apply a score for a family prior to them receiving
a bill. That score automatically applies a certain percentage
of coverage to the bill and proactively applies the
discount. Sometimes it's 25%, sometimes it's 100%. There
are no limits on who can qualify, and the same standards
are used in evaluating every family. " We've received really
positive feedback, " says Karlen. " Some of the families had
been on payment plans but never applied for GAP, and now
they're getting assistance. We're really excited about it
and encouraged. "
Karlen says Gillette Children's ultimate goal with the programs
is to remove barriers to care. " We work with teams
across the organization, and we are going to find a way for
the patient to be seen if we believe they need to be seen at
Gillette. " Gillette Children's effort to reimagine financial assistance
follows a broader trend in children's hospitals expanding
their existing programs or reimagining new ones.
As health care costs increase, patients and families remain
at the center of children's hospitals and health systems' effort
to improve financial stability and health outcomes.
Grant Heiman is a writer at the Children's Hospital
Association. Brian Busenbark is a writer and content
strategist based in Omaha, Nebraska.
Send questions or comments to magazine@childrenshospitals.org.
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CHILDREN'S HOSPITALS TODAY Winter 2023
Children's Hospitals Today - Winter 2023

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