The experience of infertility touches on every aspect of a person’s life. More than just a series of medical conditions, struggling to have a baby is emotionally and spiritually challenging, an obstacle to time management and daily tasks, socially isolating, and financially daunting. Fertility experts are charged with recognizing and responding to all that infertility brings into patients’ lives.
Investigating insurance benefits and offering innovative financial options has been an integral part of the services offered at SGFC since 1991. But, until recently, the entire financial department was located in Rockville so much of the patient/financial counselor communication occurred by phone or email.
Last year, in an effort to give our patients easier access to answers about the financial aspects of treatment, financial counselors were placed in every SGFC office as a complement to the medical team. This concept has been well received by patients who say they appreciate not only the face-to-face contact with their counselor but also the solutions and support for obstacles that can crop up along the way.
The on-site counselors are supported by a host of managed care teams back in Rockville who obtain benefits and authorizations so that the financial counselors can provide this much needed information to the patient – before testing or treatment begins. The managed care teams are organized by specific insurance companies so that each team member becomes intimately familiar with the insurance plans and has established relationships with the various provider organizations.
As Katy Geddes, Financial Services Supervisor, explains, the development of the financial counselor role has meant that new patients find out at their very first appointment what they can expect in terms of affording the fertility treatment plan recommended by their doctor.
“A financial counselor is introduced to the patient at their initial appointment as part of the team,” Katy explains. It is at that point that the counselor goes over any information gathered prior from the insurance company about what is covered and what is not. In the rare case when insurance coverage is unknown at the first appointment, the financial counselor works to verify it that day.
In the past, several days might pass between a patient’s first consultation with the fertility specialist and finding out what expenses will be covered, an interminable amount of time for most patients who are eager to move forward as soon as possible.
“The revamped process brings in counselors who are sensitive to the emotional aspects of fertility treatment as well being well-versed in how insurance companies work and what kinds of referral and authorizations are needed,” Katy says.
Senior Financial Counselor, Reinette Springirth, says the new position combines the most enjoyable tasks of her 10-year employment at Shady Grove Fertility.
“Not only do I get to use all of my skills in billing and insurance, but I get to work directly with patients, too,” says Reinette. “A big part my job is interpreting insurance benefits that our managed care team has put in place and guiding the patients on how to combine it with their treatment plan.”
Reinette relates a recent case that highlights how Shady Grove Fertility’s financial team can play a key role in someone receiving the treatment they need to have a baby.
While being monitored during a treatment cycle, a patient’s insurance denied coverage for her IVF. The managed care team at Shady Grove Fertility believed the denial to be invalid, that the patient’s case needed to be reviewed more thoroughly by the insurance company.
“The patient was understandably very distraught, thinking she’d have to cancel her IVF cycle,” Reinette recalls. The patient had already been approved for both a Capital One loan and Shady Grove Fertility’s Shared Risk 100% Refund Program and wanted to immediately move forward with those options to make her treatment happen. Reinette followed through and the patient was able to sign off on related paperwork that day.
“At that point, the patient knew that while we were appealing her insurer’s denial, she was backed up by the Shared Risk program and could proceed as planned with the cycle, no matter what the insurer finally decided.” In the end, the patient’s coverage was approved.
The financial counselor’s job is, as Reinette describes, “to stretch and find creative ways to serve the patient’s needs. We use all of our knowledge and experience to uncover insurance benefits and if they are not there, we present and explain all other options.”
One of the biggest benefits of the financial counseling team approach is the timeliness of the information presented. “It’s important for the patient to know up front what the possibilities are so they can make a decision before they have a bill in their mailbox,” Reinette says.
Treatment cycles threatened by lack of insurance aren’t the only situations that get the attention of financial counselors. Reinette recently spent some time doing research at a patient’s request to turn up the origin of an unanticipated $20 charge. “I was able to find it, and it was complicated,” she says. “I called the patient and mailed her the details. The patient joked that we’d come a long way from the time when she wanted to mail me her spreadsheet…”
Financial counselors answer questions from physicians and other staff, as well. Their communication skills and empathy are called on in the role of liaison, helping all of the team members — from the billing to the clinical staff — fit together important pieces of the ‘big picture’ for each patient’s treatment plan.
When she first meets a new patient, Reinette uses a well-known television commercial to explain her role in this challenging junction of their lives. “Everyone knows the ad for a particular phone service, with the goofy guy with the glasses, and the big crowd of people behind him — that’s me, with a great team backing me up. Without that team, I couldn’t get anything done for the patient.”
