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Tears, Gratitude, and Education: Patient Financial Advocacy

Analysis  |  By Alexandra Wilson Pecci  
   November 23, 2020

"I saw [patients' appreciation] front and center. Many people at the facilities I worked at would just break down and cry. I never forget the fact that patient advocacy is at the forefront of the patient experience at any facility," Pattie Froehling-Gilliam said during the HealthLeaders Grit Podcast.

In her years working in the revenue cycle, Pattie Froehling-Gilliam has become passionate about patient advocacy and helping people pay for their healthcare. Her work has gone far beyond setting up patient payment plans, instead extending into education, outreach, and connecting patients with programs.

For Froehling-Gilliam, vice president of revenue cycle optimization at Optum 360 and former director of vendor and financial counseling for Northwell Health, the revenue cycle is about so much more than the dollars that come in and out of a health system. It's also about helping people get the care they need without the heavy burden of worrying how to pay for it.

"… Being that advocate is being the educator to the patient and the patient's family, letting them understand what avenues are out there to help them," she said on a recent episode of the HealthLeaders Grit Podcast.

In the following podcast transcript, Froehling-Gilliam shares her ideas and experiences on how to improve the patient financial experience. It has been edited for length and clarity.

HealthLeaders: Why do patients need an advocate?

Pattie Froehling-Gilliam: If you walk into a room, and you ask people, 'What does your insurance cover and what does it not cover?' it doesn’t matter if you're white collar or blue collar, a CEO or CFO or somebody who is doing maintenance, people just don’t understand their insurance.

They don’t understand what's covered, what's not covered, or what coinsurance is. They understand deductible because it's pretty cut and dry, they understand copays. But the Affordable Care Act has "metal" plans [referring to different coverage tiers referred to by names like "gold" or "silver" plans]. People think they're insured but they don’t understand that they have an $18,000 out-of-pocket expense before anything is covered.

I've been a frontline leader, and I've seen people come in whose family member is quite sick and the first thing they think is, "I can't do this. I don’t have the money for it.' And it's very jarring to me to see that because the first thing that comes to them is finance.

It's not just in the front end. I've seen it on the back end when I've run call centers and financial counseling. … It's just heartfelt. So being that advocate is being the educator to the patient and the patient's family, letting them understand what avenues are out there to help them.

People think that financial assistance is only for people who don’t have any money; that's very untrue. Depending on where your federal poverty level is and depending on the policies at that facility, it could go up to 500% of the federal poverty level. That's about $115,000 for a family of four that could potentially get help.

There are drug companies out there that will help you to make sure that you get the services that you need or the drugs that you need at cost and help you with financial assistance.

This is what we need to teach the people of America to let them know—the insurance population and the uninsured population—that there are things out there to help you. Don’t wait until you're almost on your deathbed … to go and get help. We need to teach people what's out there from a wellness perspective, from different levels of acuity, to chronic illnesses. There's help out there, and that's where we fall short.

When you want to get your knee replaced or you go into the emergency room thinking that you have insurance and then you get a $2,000 bill in the mail, that's wrong.

We should also be teaching them what is [in] each one of these [marketplace] plans: What does it mean to them, what is the out-of-pocket expense? What are the avenues [available] to pay for it? Are they eligible for financial assistance? There are drug companies that will ensure that chronic illness patients will get their drugs every single week, so that you don’t wind up in the hospital and having to have a high level of acuity and services and post-discharge services.

That's where my passion comes into play because I saw [patients' appreciation] front and center. Many people at the facilities I worked at would just break down and cry. And, I have many letters from them that keep me grounded, saying thank you, to ensure that I never forget those people. I never forget the fact that patient advocacy is at the forefront of the patient experience of any facility, whether it's at the front, or whether it's in the back … or in the self-pay call center.

HL: If you ask most patients, they probably didn’t have an experience where someone in the business office thoroughly explained all of what you just said. Is this something that's lacking in hospitals today?

Froehling-Gilliam: Yes, absolutely. In my time at Northwell Hospital, which is probably where my passion started from a patient advocate perspective, we built a whole financial counseling department. We started with the inpatient services. We expanded that to our cancer center services … and to the emergency room to be able to have counselors there for those people who were uninsured to see if they were eligible for any government programs.

[We also offered] financial assistance as part of the discharge process, as well as educating them about out-of-pocket expenses in the emergency room.

That was the same thing that we did for the uninsured and the underinsured in our inpatient services and then we expanded it to our call center. As patients came into our self-pay portfolio, whether it was the balance after insurance or straight self-pay, we [used] propensity-to-pay scoring.

[For instance,] when New York [state's] Essential Plan was expanded, we would do some reaching out to those patients to let them know that they were potentially eligible. We were very proactive in helping all of our patients.

Now, can I tell you that every facility does this? No. But at Northwell—and I'm very proud of it—they were willing to take that chance and to invest in that whole financial counseling … because we saw a need for it. We saw a need to help patients.

HL: When it comes to dealing with patients and how it made a difference, do you have a specific story in mind that made an impact on you?

Froehling-Gilliam: There was one lady who needed a surgical procedure, she didn’t have the money to pay for it, and she was scheduled to have the services. We gave her the financial assistance and she paid it over a length of time. Based on that surgery, her quality of life was given back to her. No one else would take the chance, and we did at Northwell. We gave her that opportunity.

You know, $150,000 for a family of four sounds like it's a lot of money, but when you start putting in just the things that they need to live on—food, mortgage or rent, gas in your car, car insurance, a cellphone, putting your lights on—$150,000 will go pretty quicky. Now layer on top a $6,000 or $7,000 bill.

Just to adjust it down for them, you're an angel to them. This one woman, that's exactly what she said: "You're an angel, and I'll never forget you." I think it's really important and it's the right thing to do.

HL: How did you get into this line of work?

Froehling-Gilliam: I was working in a company that was a billing and collection agency and I just had so much passion for it. I was there for 28 years just helping people.

It has driven me for the last 42 years to just get better and strive to have more passion for people to help them. It just hurts me that there are so many people who have insurance who don’t utilize it from a wellness perspective because they're afraid.

Get out there and educate them. And take them off the defensive. … People get defensive when they see high bills. Teach them what questions to ask. People who get big bills have a tendency to get on the phone and kind of be on the defensive, and say, "I don’t understand why I owe this bill."

If I can make a difference in one person's life or 10 people's lives, then kudos to me. There's a reason why I'm doing it.

Alexandra Wilson Pecci is an editor for HealthLeaders.


Patients understand copays and deductibles, but the rest of their insurance coverage is often a mystery.

Educate patients about their insurance and how they can pay for their healthcare services.

Proactively reach out to patients who might be eligible for financial programs.

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