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Solutions for the No-Pay Self-Pay Patient

Philip Betbeze, for HealthLeaders Media, May 14, 2012
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PPACA doesn't necessarily help
Until enrollment is greatly simplified, hospitals and health systems will always be looking for better ways to find coverage for the uninsured. For hospitals and health systems, losses stemming from the uninsured can be huge. Hospitals write off millions in bad debt and provide charity care dollars for patients who can't easily find coverage—and seem poised to continue to do so. That's despite the looming implementation, through the Patient Protection and Affordable Care Act, of the requirement for citizens to obtain insurance, slated for 2014. Even in 2014, when the health insurance exchanges and penalties for not obtaining health insurance kick in, patients will still have to take action, and that's exactly where the current problem lies, says Phil Lebherz, executive director of the FHCE, a nonprofit he founded in 2004 to help find already-existing coverage for uninsured in California.


"They've made it very difficult for people to sign up," he says, speaking generally of programs that provide assistance to the uninsured. "It's a big bureaucracy, with a fragmented system that's difficult to navigate."

FHCE started with a simple pamphlet in 2004 that listed all the available options for uninsured patients to obtain coverage. The pamphlet was simple, but the number of healthcare coverage options was extensive, and navigating from there was difficult for patients who, in addition to medical concerns, often have difficulty reading and comprehending. Add to that the waiting at the various assistance agencies. Given the huge bills hospitals generate for even the most mundane of care, for many patients it's easier just to ignore the question of payment.

Since 2004, the FHCE, which is funded in large part via donations from a mix of foundations, companies, and individuals, has gone digital. Users navigate to the main webpage, answer five simple questions, and the site "funnels" them, Lebherz says, to programs for which they are eligible. It provides them the forms they need to fill out, instructions on where to go to file the form, and what they need to take with them (e.g., a birth certificate or a copy of a recent tax return). Anyone can use the site, and it's free; many do come there on their own. He estimates that based on what he's learned since the site went live, first in California and then nationwide, that up to 30 million of those counted currently as uninsured are eligible for some kind of assistance.

But depending on patients to do all of this on their own is not the idea, says Lebherz, who in his day job is founder, chairman, and CEO of LISI, a San Mateo, Calif.–based company that provides eligibility support services for employee benefits insurance brokers. Neither is it the idea to just determine whether the self-pay patient is eligible for assistance, which is all the site is able to do now.

Point-of-care enrollment is the ultimate goal, he says, and that means hospitals have to get involved.

Many, especially in California, already have.

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