Helping self-pay and uninsured patients afford primary care
I remember the first time I lost a patient due to lack of health care insurance. This was about 20 years ago, before the Patient Protection and Affordable Care Act (ACA). I was employed for a large Catholic non-profit hospital system in a residency practice with a fairly robust charity care program for uninsured patients.
My patient was a 40-something female with high blood pressure. She had a job cleaning houses but lost her health insurance when her spouse changed jobs. She stopped her meds and stopped coming into the office. Within a year, she went into renal failure, went to the hospital and died from complications.
Her medication likely cost $10 to $15 per month. She just did not know how to get the medication without insurance and may not have known about our charity care program, or let that enrollment lapse. Her death was easily preventable.
More patients are losing insurance coverage
With H.R. 1’s passing and pending implementation, potentially 16 million people will lose coverage during the next year. Already, rising health care premiums have made it so that many patients have no other option than to self-pay.
Before the ACA, free clinics were available in our area, as well as vaccine clinics and a rotating lab at local churches where patients could purchase cheaper labs. Women’s health screenings were covered by our local cancer center.
Because of the ACA, most of these resources went away. Patients were able to access care they previously could not, so these resources were no longer needed. As we look at these new challenges, we see patients unable to afford a plan off the exchange, being dropped off Medicaid and having a hard time getting back on. Some patients who live at the margin lack reliable access to the internet or email, and the digital knowledge needed to keep up with changes.
Connect your patients to resources
Ways to help when patients become uninsured
I now work in an independent practice, where we take all insurance plans and have a few cash pay patients. As we brace for the challenges ahead alongside our patients, here are some of the strategies we’ve put in place to help make sure preventable losses like the one I encountered decades ago won’t happen again:
Communicate proactively. As I meet new patients with coverage lapses in their history, I always stress that whether they have insurance or not, we are still their primary care source and medical home. We can help navigate getting care without insurance. I hope that if they ever have lapses in care again they will remember to reach out to us for assistance, not stop all meds and have a complication.
Determine reasonable rates so patients can afford care. Prices, for example, should be comparable to payer rates in most cases.
Build resources for cost-effective labs, imaging and medications. At my clinic, we called national laboratories to find out which ones have cash-pay options.
Know the self-pay rules for Medicaid and Medicare. Make sure you also meet compliance with laws like the No Surprises Act.
Make staff aware of available resources, and train them on pricing and payment options. I have these conversations often so we are all on top of the best ways to help self-pay patients.
In family medicine, we form strong bonds with patients and their families. They do not go away simply because their insurance does.
Stacey Bartell, MD, is the AAFP's medical director of career and practice strategies. She focuses on enhancing the AAFP’s member education and resources, as well as supporting career and practice related policy and governance work. She brings many years of experience leading quality improvement and practice transformation initiatives. Dr. Bartell operates a solo, small practice in Michigan.