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How providers can help patients with open enrollment

While providers are typically addressing their uninsured patients year round, open enrollment represents a significant opportunity.

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Open enrollment is fast approaching, and the sign-up period for the Affordable Care Act marketplaces represents an opportunity for your organization to improve the uninsured rate in your community.

Providers have an incentive to ramp up open enrollment services, and with just two and a half months before the period begins, now is the time to consider how your organization will approach the sign-up window.

While providers are typically addressing their uninsured patients year round, open enrollment represents a significant opportunity. A new Gallup poll showed drops in the uninsured rate are clearly aligned with open enrollment.

“The [uninsured] rate may continue to decline in future years although…maybe only in the first quarter of each year as U.S. adults continue to make use of the exchanges,” Gallup reported.

According to the American Hospital Association, uncompensated care cost providers $42.8 billion in 2014—so while the uninsured rate continues to decline, there is room for improvement.

Here are a few questions providers might have about their role in open enrollment.

Why should providers invest in open enrollment services?

Hospitals are a key setting for insurance enrollment from both the provider’s and the patient’s perspective. As all providers know, hospitals struggle with non-paying patients. Capturing these patients onsite when they need coverage the most benefits both the provider and the patient.

Having advisors available onsite means they are able to invest the necessary time and resources into investigating your self-pay patients’ situations—often, these patients are simply unaware of the low- or no-cost options available to them.

Further, hospitals are an intuitive place for patients to discuss their coverage needs. They’re easy to find, clearly marked, and patients expect providers to have answers about insurance options—even if they don’t.

Why are my patients losing coverage?

Patients lose coverage for all sorts of reasons, and this can make it hard for hospitals to see how they could provide assistance to all the patients who need it. It might be as simple as an address change, or as complicated as a visa or immigration issue.

At Bernard Health, our advisors often spend hours, and sometimes days, tracking down all the right parties, from the Social Security Administration to Healthcare.gov and beyond, to find answers to patients’ complicated questions. Without dedicated investment, these patients slip through the cracks.

Most often, patients don’t sign up for marketplace coverage or Medicaid because the process is confusing. Many say they don’t understand the marketplace, and they are often required to submit multiple documents to prove identity, income, address and more. Throw in language or literacy barriers and the process can become nearly impossible.

Also, health insurance itself can be overwhelming. Many patients struggle with terms like “deductible” or “coinsurance” or figuring out whether your hospital is in their new network. These issues represent barriers to accessing coverage, even when it’s affordable. Advisors are key in walking these patients through both their plan options and the sign-up process.

What are my choices?

There are a number of ways providers can help patients with open enrollment. Hospitals can enlist the help of ACA navigators, Medicaid enrollment vendors, or have existing staff become Certified Application Counselors. These people can help patients sign up for a plan, but they are prohibited from helping evaluate options or recommending anything.

If you want to provide your patients with another level of counsel, you may consider partnering with licensed health insurance brokers or noncommissioned advisors. In addition to helping people sign up, licensed brokers and noncommissioned advisors can advise patients on network restrictions and out-of-pocket costs, among other comparisons. They can also make recommendations based on an understanding of the patient’s needs.

Now is the time to evaluate your options and consider how your organization might best address your self-pay and uninsured patients.


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Alex Tolbert

Alex Tolbert’s passion for healthcare began while studying health law as a third year JD/MBA student at Vanderbilt University. Seeing a need for a go-to source to help consumers and businesses alike get the most out of their healthcare options, Tolbert founded Bernard Health in June 2006, while still a graduate student. Nearly a decade later, Tolbert is a recognized expert in health, Medicare and COBRA insurance and medical billing, and is a regular columnist in both The Huffington Post and The Tennessean.

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