Ability to Pay
Kathleen C. is a relatively new patient with Hudson Headwaters. She’s been coming to us for help with ongoing women’s health issues for more than a year. At one time she was eligible for Medicaid. Then she wasn’t. The bills started to pile up. Then she went through a divorce. Now she’s a single mom with little support, and the bills keep coming, including Hudson Headwaters’. Good news is, she got a job and now has health insurance, but the plan has a high deductible. She still can’t afford the cost of care, and still has that stack of old bills to add to the new ones. We sent her an automated notice about the risk of going to collections.
“To provide the best care and access to that care, for everyone in our communities.” We take our mission seriously. “Everyone” means everyone, regardless of ability to pay. It’s why we have a Sliding Fee Discount Program. As a Federally Qualified Health Center (FQHC), our Sliding Fee Program is supported by federal dollars. Eligibility is based on income and family size. That’s it. Insurance status has no bearing on eligibility. We also offer a Pharmacy Assistance Program to help those who have regular/ongoing medication needs, but cannot afford their prescriptions. Working directly with pharmaceutical companies, our staff helps eligible patients get brand-name medications for free.
We currently have about 2,000 patients actively using our Sliding Fee Program (and about 200 with the Pharmacy Assistance Plan)–less than 3% of our patient population. (Another 400 apply each month, but are deemed ineligible). These numbers are down almost 20% from last year. We expected a reduced number of patients needing the Sliding Fee Program as a result of the Affordable Care Act. But we’re concerned that there is a misconception about eligibility. We recognize the need, now more than ever, for more education for our staff and our patients.
Turns out Kathleen C. was never informed about the availability of our Sliding Fee Program, or offered an application. Presumably, this is because our system showed she had insurance. But the high deductible plan she is on doesn’t cover the whole charge for each visit, leaving her with more than $150 of monthly charges she can’t afford to pay. Kathleen called us. “Please,” she said. “I want to pay these bills, but…”
Our Sliding Fee Program and Budget Plan staff (part of Patient Support Services) listened to her story and understood immediately how we could help. In addition to calculating a monthly budget plan Kathleen could afford, she was encouraged to apply for Sliding Fee discounts. “I don’t think I’m eligible,” she commented. “I already have insurance.” She certainly was eligible, and how! Her per visit charge was reduced to $33. Kathleen is incredibly grateful for the extra time our “financial care managers” spent with her mapping out a plan.
“Insured, underinsured, uninsured. It doesn’t matter.” says Bonnie Jenkins, Patient Support Services Manager. “I am so passionate about patients learning about these programs. Imagine how much we could have helped this patient if she’d started on Sliding Fee months ago. Please don’t presume a patient is not eligible just because the system shows insurance. Always offer our Sliding Fee Program pamphlet and application to patients when they come to our health centers.”
Our Sliding Fee Program is at the very heart of what we do, and is part of what makes Hudson Headwaters unique as a provider of care in this region. Let’s help get the word out, shall we?