Joey Wahler (Host): It's an important part of the healthcare experience. So, we're discussing Jefferson Healthcare's Financial Counseling Commitment. Our guest, Damon McCutcheon, he's Patient Access Manager for Jefferson HealthCare.

This is To Your Health from Jefferson Healthcare. Thanks for joining us. I'm Joey Wahler. Hi there, Damon. Welcome.

Damon McCutcheon, CHT-A: Hi, Joey. Nice to be here. Thanks for having me.

Host: Absolutely. Great to have you aboard. So first, give people an idea please, as patient access manager, what exactly do you do on a daily basis at Jefferson Healthcare?

Damon McCutcheon, CHT-A: It's a good question. It's a rather odd title. So, my responsibility is managing the registration staff and also our financial counseling team.

Host: And so, when we talk about financial counseling, as it relates to healthcare and your job in particular, what do we mean by that?

Damon McCutcheon, CHT-A: Yeah. So, our financial counselors are patient-facing resources who are able to answer questions for patients on billing, on insurance. They're actually certified navigators through the healthcare exchange, so they're able to sign patients up for qualified healthcare plans or for Medicaid, and also work with patients on some of our robust financial assistance offerings.

Host: So, simply put, you help explain to those that need it how they can find the money to pay their bill, right?

Damon McCutcheon, CHT-A: Yeah. We really focus on trying to reduce or remove those financial barriers so that patients are able to access healthcare when they need it and not just for those emergent situations. So yeah, we really do strive to support the community in that.

Host: And so, speaking of which, Damon, why would you say this work is so important to people in East Jefferson County?

Damon McCutcheon, CHT-A: Yeah, it's a good question. So, I mean, we all know that the healthcare world is complicated, complex. And it can be really frustrating and challenging for the average patient to try to navigate through. And health insurance and billing especially can be really really confusing. And for patients in East Jefferson County as a rural area, their closest resource is Jefferson Healthcare. Outside of that, they may have to travel for over an hour to get to their next closest location.

So, making sure that we have the resources available at their fingertips to really provide that one stop shop in answering the questions, helping with breaking down those financial barriers, payment plans, charity care options, and making sure that patients have insurance set up for them is really crucial to ensuring continuity of care for our folks.

Host: Gotcha. And speaking of insurance, I want to ask you a few things about your role where that's concerned. Part of what you do is simply trying to get people insured. Before we go any further, I wonder, particularly in the community you serve, how many people still try going without insurance out of necessity?

Damon McCutcheon, CHT-A: We still see a sizable part of the population who present without any insurance, and it's challenging because healthcare is expensive. And typically, we see patients without insurance, not doing those preventative maintenance visits, but waiting until conditions exacerbate. And then, they end up going directly to the emergency department, which emergent care, given its nature, is significantly higher out-of-pocket costs. And so, it's a challenge on the patients and on the system of not having that preventative care in place ahead of time to try to route these patients appropriately.

Host: And so, for those to whom having insurance isn't second nature like it is to some others, remind people why it's so important to have health insurance.

Damon McCutcheon, CHT-A: Absolutely. I like to look at just kind of a general example of, you know, if I'm a relatively healthy middle-aged person, I might have a couple of underlying conditions, you know, a history of heart disease, asthma, something of that sort. If I do my normal preventative care visits and am able to keep up with whatever my medications are, my prescriptions, go see my doctor, when I'm supposed to maybe some routine lab tests or some imaging tests, I would expect to pay a couple hundred dollars out-of-pocket for a normal series of visits to keep up with that. You know, depending on insurance, it's going to vary one way or the other, versus if I look at that same situation with someone that doesn't have insurance and waits until things progress to a point where they do need to present to the emergency department, just to walk through the door, we're looking at $1,000 plus, and then depending on what preventative measures or life-saving measures need to happen there, whether or not they are kept overnight for observation or, even worse, we're quickly escalating in the tens of thousands of dollars responsibility. And if you are uninsured, that's a lot of out-of-pocket to have to deal with.

Host: And so, if that does occur, if someone is uninsured or underinsured, once those bills start to arrive, it creates a problem on both ends, right? Because it creates debt for the patient, obviously, but it also creates extra work and extra really unpleasant experiences on the healthcare side in terms of having to pursue that debt, right?

Damon McCutcheon, CHT-A: Correct. Yeah. No one likes to talk about money or money is due. And yeah, it's definitely a challenge and a stressor on both ends of there.

Host: And so, many people are insured through their parents until adulthood when they're younger and then they're suddenly faced with decisions about independent coverage. So, I'd imagine young adults in particular are often very uninformed about insurance, right?

Damon McCutcheon, CHT-A: Not just, but yes.

Host: And so, you've got young people just for the first time, pretty much, oftentimes, coming into contact with the system, but then in the community that you serve, you've got older people in the same boat as well. So, how do you go about educating them all?

Damon McCutcheon, CHT-A: Absolutely. We try to partner with local organizations to get the word out holding health events joining community events to speak to and answer questions. But really, we rely on our financial counselors as that resource. As patients present to the hospital, our registration staff will ask for insurance information. If a patient is not insured or has questions, we immediately route them to our financial counselors to try to make sure that we're preemptively answering those questions, helping them get set up with whatever they may need. Some insurances even allow for some retroactive coverage that we can help with. So, really trying to capture those patients as they're presenting and get them the information at their fingertips.

Host: So, just about anyone that's tried to get health insurance knows there are many options. What advice do you have for people that don't know how to start, that don't know, for instance, job one in this case, which is kind of what kind of a plan to choose, right?

Damon McCutcheon, CHT-A: Yeah. That's a great question, honestly. The biggest piece of advice that I can offer is don't go into this alone. Utilize your resources, whether that be a local broker that knows your area, who can help guide you through the process, whether that be reaching out to our financial counseling team, who also can help walk you through the process and sign you up. But don't try to go about the process by yourself because it's complicated, it's complex. And there so many nuances that can be missed if you don't know the questions to ask.

And honestly, the top two questions that I can suggest for people, some of the biggest frustrations that I see patients presenting with, are to make sure that when you are shopping for a plan that you know where you want to receive your healthcare at, because plans are going to be contracted with different hospitals. No one's contracted with everyone. So, making sure that you're looking to purchase a plan that allows you to seek care where you want to seek care and with the providers that you want to seek care with or at least has some level of out-of-network benefit. We see challenges in our community where patients may find a plan that's very reasonably priced, has some great options with it. However, the fine print is they need to seek care at Whidbey Island, which as a crow flies, it's only a few miles from us, but it requires ferry transport, which is a cost, which is a limited schedule. And if you're having to go to frequent medical appointments, a couple hours commute back and forth and $30, $40 for a car round trip adds up very quickly. So, making sure that you know where you want to seek care and that you are voicing that to whomever is helping you in your purchase is imperative.

The other piece that I would recommend is really understand what your out-of-pocket responsibilities are. There's a myriad of plans out there. Some of which have really low monthly fees, but may have some sizable out-of-pocket requirements for each visit that you have. Conversely, you may have something that it costs you more monthly, but has a much lower out-of-pocket per visit. So, really understanding what contract you're entering with your insurance is imperative to really understand what your out-of-pocket is going to be. Those two things I think are crucial when shopping for a plan and entering that contract with an insurance company.

Host: And so, it sounds like, Damon, in essence, what you're saying here is it's the old adage you get what you pay for or look at the fine print or both. Because if you go for that lower premium, that's probably going to mean that you're getting less coverage, right?

Damon McCutcheon, CHT-A: Yeah. In short, that's not an untrue statement. And for some folks, that may work with your lifestyle and your expectations. But, you know, that's really a decision that you as a consumer need to make and having someone help guide you through that process is, again, I can't express how important that is.

Host: So, a couple of other things. Let's say someone looks everything over as far as insurance options go and they say to you guys at Jefferson Healthcare, "Hey, look, I realized that plan B is better for me and my family or whatever the situation may be than plan A. But I just can't afford it." What happens then?

Damon McCutcheon, CHT-A: Yeah. That's another great question. Healthcare in general is expensive, and insurance matches that. Fortunately, Washington State has a number of low-income options. So depending on where a patient sits financially, there are several free or subsidized plans available, whether that be our Apple Health, which is Washington's Medicaid or some of our qualified health plans, which are like our Cascade Care Plans, which Washington State has both federal and state subsidies that help offset those monthly fees. So depending on where a patient sits financially within their household, there may be some lower income options available for them. And that's something that our financial counselors are equipped to handle questions and even sign folks up for and do the scrubbing process as well.

In addition, all hospitals within Washington state are required to offer charity care or financial assistance, and Jefferson Healthcare actually goes significantly above and beyond what the state mandated requirements are, so we have a pretty robust financial assistance program that's available regardless of your insured status. So, we're really trying to break down those financial barriers. We want to make sure that our community has access to the healthcare that they need regardless of where they sit with things. So, that's basically what we're looking at support options out there.

Host: And so, when you talk about offering either the financial counseling that you covered earlier or the charity care that you just touched on, who's eligible for this help through Jefferson Healthcare's financial counseling expertise?

Damon McCutcheon, CHT-A: So, everyone can, and I encourage everyone to reach out to the financial counselors with any questions or concerns that they may have. They're a tremendous team of individuals that are very, very knowledgeable in what they do. As far as the financial assistance, we offer prompt pay discounts. We offer payment plans. So if you aren't able to pay your lump sum right up front, we can break that down into interest-free payments. There really aren't too many barriers requirements with those plans.

The financial assistance piece or charity care does have some more specific requirements that basically it's calculated off of your family size. And family is basically the number of individuals living under the same roof. And then, that household income. And it's again more robust than you might think. You know, if you're a family of three and have a household income of under, I believe it's $103,000, you may very well qualify for at least 50% off of your out-of-pocket requirements. And depending on where you sit within the sliding fee scale, which is based on the federal poverty limits, you may qualify for up to a 100% discount on your care. We also have our pharmacy team that also looks for patients that may have infusion responsibilities and such with those expensive drugs. We also can look for grants or copay assist programs that may be available on top of everything.

Host: And so, in summary here, Damon, how rewarding is it for you to be involved in this line of work where oftentimes you're really helping change people's lives, right? Because being insured for the first time or fully insured if they're underinsured, especially if they've had health problems themselves, if they have a family, even if there have been no major issues, it really can make a person feel more secure and complete and just give them peace of mind going forward, right?

Damon McCutcheon, CHT-A: Absolutely. And, again, managing such a tremendous team as we have at Jefferson Healthcare, I receive calls and emails frequently from patients, just sharing their appreciation. Some of them even in tears with just how overwhelmed they might have been with the process, with their financial burdens, et cetera, and to have someone hold their hand through the process and be able to relieve some of that or all of that concern and let them focus on just getting healthy again, it's amazing. Again, I just can't say more about what a tremendous team we have here.

Host: That's great and that really punctuates just how important what you and yours do is. Well, folks, we trust you're now more familiar with Jefferson Healthcare's financial counseling. Damon McCutcheon, keep up the great work. Obviously, it's ultra crucial in the community and thanks so much again.

Damon McCutcheon, CHT-A: Thanks so much.

Host: And for more information, please visit jeffersonhealthcare.org/billpay. If you found this podcast helpful, please share it on your social media. I'm Joey Wahler. And thanks again for being part of To Your Health from Jefferson Healthcare.