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Wednesday, March 21, 2018

Insurance trends create challenges for medical providers

(Editor’s note: This is the second in a series about how changes in the healthcare industry affect Glendive Medical Center.)

By Jason Stuart

Ranger-Review Staff Writer

Shifts in the healthcare industry in recent years combined with federal and state healthcare policy changes have been largely positive, according to Glendive Medical Center administrators, because they have led to wider access to healthcare for more people. 

While things like the Affordable Care Act and the recent Medicaid expansion have provided for greater patient access, hospital administrators also say there have been some troubling negative trends, especially when it comes to health insurance plans, which are leading to more financial difficulty for patients and a wider range of debt that the hospital is left trying to collect.

High Deductible Health Plans create challenge for patients, hospitals

While Medicare and Medicaid patients combined make up the largest percentage of GMC patients, most of the rest of the patients GMC sees are insured by private insurance, but there’s some wrinkles in that as well, as changes — mostly to the patient’s detriment — in health insurance policies over the last 10 years has led to a higher number of people — even insured people — falling into the “self-pay” category.

“We do have a large ‘self-pay’ piece,” said GMC Chief Financial Officer Bill Robinson, explaining that 4 to 5 percent of the hospital’s patients in 2017 fell into that category, but that 10 to 15 percent of those actually did have health insurance.

What has changed, Robinson explained, is the advent of High Deductible Health Plans (HDPs), many of which come with a $5,000 deductible and no co-pay options. Since patients on those plans  have to pay all of their deductible out of their own pocket before the insurance begins paying for anything, Robinson said GMC now classifies those patients as “self-pay” until they hit their deductible. Furthermore, those HDPs have actually led to more patient bad debt, according to Robinson.

“Ten years ago we didn’t have HDPs, and a lot of those dollars end up in bad debt,” he said.

Another 4-5 percent of the hospital’s patients still have no health insurance whatsoever, Robinson said, adding that the hospital seldom collects a dime for services rendered to those people.

“Ninety to 95 percent of that ends up being uncollectable,” Robinson said of debt from uninsured patients.

Payment options are available

However, Robinson stressed that GMC is continuing to work on expanding and improving payment options for its patients, no matter their situation.

For one thing, the hospital continues to give away a substantial amount of charity care, Robinson said, especially in the aftermath of the Affordable Care Act, which “effectively doubled” the federal poverty level for the purposes of determining if a person qualifies for either full or partially-paid free care. Robinson noted GMC has tallied about $750,000 in charity care given to patients over the last three years.

For those who do not qualify for charity care — which a quick, free application at the hospital will help determine — Robinson said the hospital wants to do everything they can to make it easier for them to pay their bills and to try and cut down on the number of people who end up having their unpaid bills sent to collections.

Everybody, no matter their personal financial situation, is eligible to qualify for one of the hospital’s current repayment plans. The basic payment plan can go for 12 months with no interest with a $50 minimum monthly payment, but Robinson noted it can be extended further if needed with one phone call.

“And if you need more time, in a phone call with one of our patient advocates we can go up to 18 months interest-free,” he said. 

“For larger bill amounts that people need to stretch out longer, GMC has also recently secured a “special deal” with American Bank Center through which the hospital secures a guaranteed loan for the patient — meaning the patient doesn’t have to go through a credit check and can’t be denied since the hospital is the guarantor — to cover the cost of their bill. The loan repayment can be stretched out over up to 10 years, Robinson said, adding that GMC is not done looking for new and innovative ways to make it easier for patients to pay their bills and cut down on the hospital’s bad patient debt.

“We’re also looking at other ways to enhance our payment programs,” Robinson said.

Reach Jason Stuart at rrreporter@rangerreview.com.

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