Help Care: Hospital Helps Patients Help ThemselvesHelp Care: Hospital Helps Patients Help Themselves

Since its founding in 1882, Children's Memorial Hospital in Chicago has never turned away a sick child who couldn't afford treatment. Nevertheless, the day a child shows up there isn't the time parents want to learn their insurance doesn't cover the necessary treatment.

As companies tweak or even switch health-care plans regularly looking to save money, patients often can't keep track of their coverage. It's health-care providers that have to deal with that confusion, since they're the ones that end up informing a patient when his coverage comes up short of what he expected. Medicaid eligibility can be even more complex, sometimes changing without the covered person knowing it.

Amid this growing complexity, hospitals such as Children's Memorial are trying to get patients information more quickly about how much their insurance will cover for a particular surgery or treatment. Toward that end, Children's Memorial has invested in a call-in patient registration system that it opened last year and that beginning in January will give hospital phone representatives near-real-time electronic links to coverage information provided by insurers, letting them quickly get the information they seek about a patient's coverage. "Our mission has always been that we'll treat all children," Children's Memorial CIO Stan Krok says. "But we've found the sooner we deal with the issue, the better."

With a call center in place, the push is on to get patients to register days before arriving at the hospital so the staff could check their eligibility. That has required a cultural change to get physician offices to stress the importance of early registration. But it's working. A year after the call center opened, 90% of patients register between three and 28 days before treatment.

Government regulations might also help hospitals become more customer-friendly. The Health Insurance Portability and Accountability Act will require standardized electronic transaction standards by this time next year. That could make it easier to move toward consolidated billing across the hospital and various independent physician groups that work there. "It gives us a common platform to work from," Krok says. Anyone who's had surgery and received bills from the hospital, doctor, anesthesiologist, and a private lab knows how that could simplify the payment process for patients.

But ultimately, Krok says, there needs to be more fundamental changes in the relationship among the employee, insurance company, and health-care service provider. "The patients need to better understand their coverage," he says. "The individuals will have to get more involved." Hospitals like Children's Memorial are taking the first step by giving patients more information, sooner.