Darrell Rebouche (Host): When you think about going to the hospital, you're probably gonna think about your own health or the health of your loved one first, and that leads you to think about the doctors and the nurses and the other healthcare providers who will be taking care of you. And certainly, the clinical side of your hospital stay should be your focus.

But one critical component is something you might not think about, and that is the financial side. Hello, everyone. Thank you for joining us for Health on Point, presented by Willis-Knighton Health. I'm Darryl Robichaux, your host, and our guests for this episode will be able to answer all your questions about the financial side of your hospital stay.

Please welcome Wendy Ward, who's an assistant vice president for finance at Willis-Knighton Health, and Owen Rigby, who is the director of the business office at Willis-Knighton. Thank you both for being here

Wendy Ward, MHA: Thank you for having us

Owen Rigby, BS, MLA: Thank you

Darrell Rebouche (Host): Yeah. Owen, let's start with you 'cause the business office is your domain. So you have a responsibility to the health system and most importantly to the patients.

So can you line out what the responsibilities of the business office are?

Owen Rigby, BS, MLA: We do everything to get the patient's claim paid. So we file the claim to insurance. If they're slow responding, we'll follow up with the insurance. once the payment is received, we make sure it's correct, you know, that it's been paid correctly by the insurance company. We-- If there are any problems, if there are any, charges that were denied or the claim was denied, then we go back to the insurance company.

We'll appeal with them to try to get the claim paid. We'll then, once it's paid, we'll send the statements out to the patients and answer any questions that they have

Darrell Rebouche (Host): Wendy, you know, you're going to be a patient advocate. I think people don't necessarily realize that, but, you know, while you're in charge of the finances, our mission, Weill's Knight mission is always to place the patient first, and how does that come into play from the business side?

Wendy Ward, MHA: Well, it's quite easy. Our, our business office staff is here to serve the patient, and so the patient is their primary concern. We have to often remind them that, you know, their duties are to collect money and, and to service the hospital always as well as the patient. But yeah, the patient is their primary concern. we're here to answer questions, certainly make our patients feel more comfortable and to let them know that we're here to help them. They, they're not in this alone. You know, they're fighting a health crisis if they're in the hospital, and it's our job to take care of the financial side for them, to partner with them

Darrell Rebouche (Host): In large measure, Owen, the financial side involves insurance, insurance claims, communicating with the insurance company. What can a patient or the patient's family do to help make sure that that process is as efficient and satisfying as it needs to be?

Owen Rigby, BS, MLA: Well, I, I think that starts at registration. if they could help us by, by making sure that all the information that's gathered at registration is correct, their name, their address, their-- what insurance they have, the policy number, all of that, will really, really helps to get the claim, you know, paid, paid correctly and paid sooner

Darrell Rebouche (Host): And Wendy, I think part... You know, we talk about, rights and responsibilities, and I think one of the responsibilities a patient may have, and correct me if I'm wrong, is to know the answers to those questions before you show up. Of course, if it's an emergency, you know, that changes the equation altogether.

But Owen talked about the information you need to give when you are being admitted to the hospital or that someone needs to give on your behalf. So how do people prepare? How do they organize to know that they have the answers that are complete and as helpful as possible on the hospital side?

Wendy Ward, MHA: Well, Daryl, it always helps when they have their insurance card available in their wallet. I try to keep my insurance card with my driver's license. I rarely leave home without my driver's license, and that insurance card is right behind it. if you can provide that, that gives us most of the information that we need upon arrival at the hospital.

Also, answering the questions and not getting upset when we have to ask you questions that you've answered before. You know, making sure that your name is correct, your address, the insurance information is correct. Because once again, we're here to collect money from that insurance company from the-- for the premiums that you've paid for that insurance. So we want you to get the most out of your money for y- with each insurance company that you have. also, that information being correct keeps us from having to correspond with the patient more often. verify, you know, send a mail or send an, a phone call or a text. We like to have the information up front

Darrell Rebouche (Host): You said something about every kind of insurance you might have. Oh, and I think some people might not think, "Okay, I turned in my insurance card, but if I'm a certain age or of a certain demographic, I might have another insurance that might be my primary, say Medicare, in combined with my employer's insurance."

So how important is it to know what you have as you come in?

Owen Rigby, BS, MLA: Well, it's very important to know what insurance you have And it is extremely helpful if you know-- if you can tell us which one is primary, which one is secondary. There are times, you know, an older worker, will still, what's, what's co-considered an older worker, may have a group policy that's primary and Medicare is secondary

Darrell Rebouche (Host): I think all of us are older workers.

Wendy Ward, MHA: So

we know about these things

Darrell Rebouche (Host): we are in touch with that, absolutely. So Owen, are, are, are the hospitals required to submit insurance claims? How does that work? Is that, is that a law? Is that a policy? How does that work?

Owen Rigby, BS, MLA: Right. For gov- for government payers, we're really required to submit a claim. And, and then on the commercial side, it depends, on what the contract says. there are, providers, and I'm talking mainly here physician offices, that will give you the forms to file your own insurance.

We are never gonna do that if... And, and, and let me add, we're, we're talking here about what we bill, what Wendy and I take care of is the hospital side. So any claim that you may have with any of our hospitals or WickCare, any of the WickCares. If it's a physician's office, there's a different group that does that billing.

But if it's, it's the hospital, related, we'll do that billing. We will always file your claim for you

Darrell Rebouche (Host): That's good to know. Wendy, I think the, the timing may frustrate some people sometimes. Is there a lag? And how quickly can people expect to hear from the hospital in terms of a bill or a statement that may or may not be a bill? And then the ultimate resolution to all of these claims, there's some back and forth sometimes.

Wendy Ward, MHA: I'm glad you asked that question. Recently, we implemented a new letter in our process. And this process-- this letter would acknowledge your visit to the hospital for either an outpatient, procedure or an inpatient stay. And this letter will acknowledge, once again, your visit with us, letting you know that we've received your claim, we've processed it.

It's been sent to the insurance company, and as soon as it's processed by the insurance company and paid, you will receive a statement from the hospital showing your balance that you owe

Darrell Rebouche (Host): So those letters are going out monthly, periodically. I mean, Owen, do you have any idea about the rhythm of that?

Owen Rigby, BS, MLA: Yeah, weekly. those letters go out weekly

Darrell Rebouche (Host): So if I go to the hospital and I have, say, an outpatient procedure, or if I have a hospital stay for two or three days, the bill that I will get will start coming to my house at about what timeframe after I'm discharged?

Owen Rigby, BS, MLA: Well, the letter will, the letter will come shortly after the claim is filed. that depends, on the type stay that you have. If you come in just for lab work, you know, those are, those are quick and easy. that claim will drop generally three days after you have the lab work. So that will go out, you know, that'll go out very quickly to the insurance company.

The letter will go out the following week, or the fol- the next Monday it should go out

Wendy Ward, MHA: And those only go out once, right, Owen?

Owen Rigby, BS, MLA: Right. Right. It goes out for, for your primary insurance. when we, when we submit the primary insurance, we'll send the letter to you. That letter actually goes out the next day after the claim is filed. but typically we run those on Monday. So, depending on how long it takes to get them printed and, and get in the mail to get it to you, but you should get it the week after, your service

Darrell Rebouche (Host): And not to belabor the point, but after that, everyone on both sides, the hospital and the patients, are kind of beholden to or at the mercy of, for lack of a better phrase, the insurance company's schedule, how quickly they process the claims. can you talk about that a little bit more, Wendy?

Wendy Ward, MHA: Well, I think Owen was about to jump in there. some of them, some of them process as soon as three to five days. Owen, I think you said seven to 10 days. Is that right?

Owen Rigby, BS, MLA: on a lab claim, yeah, they're, there's some insurances that are very quick to pay insurance claims, and we will get them. It could be five days, but, you know, certainly within 10 days. If it's a more complex, case, if, you know, if the patient's inpatient for a long time, that will take longer.

It'll take longer for us to file that claim, and it will take the insurance company longer to pay it. They may come back and want some additional information, like an itemized bill or a copy of the medical records, and if that's the case, you know, then we have to gather that up. We have to send it back to them.

Some we can send electronically, some have to go through the mail. But we'll send that back to the insurance company, and then they process it. If there's a denial, if they deny the claim for any reason, that takes longer, of course, to get the claim paid. But, w- if they deny the claim, then we, we work with the insurance company and try to get that, that denial reversed.

We'll appeal that denial and try to get that reversed and get that claim paid

Darrell Rebouche (Host): That goes back to what we were talking about at the beginning. You are, a health system is a patient advocate in so many ways. This is Health on Point, presented by Willis-Knighton Health. Our guests are Wendy Ward, Assistant Vice President of Finance at Willis-Knighton Health, and Owen Rigby, who is the Director of the Business Office at Willis-Knighton.

Again, thank you so much for being here. So when you get those letters and you get those statements and you get those bills, sometimes they're a little bit difficult to discern, figure out what's going on. Walk me through it, Wendy. How do I look at it and say, "Okay, this is what I owe. This is what is pending.

This w- is what I'm gonna have to pay out of my pocket"?

Wendy Ward, MHA: On the statements that are received, it does state clearly what the patient responsibility is. Now, if you disagree with that or if it's obvious that it's not the right amount, please call the business office. Owen can provide the phone number. We have the phone number available, for you. Please call them. They will be glad to review the claim with you and explain to you what is and what is not your patient responsibility. And then at that time, we can discuss like payment arrangements or financial assistance. Once again, we're here to help the patient

Darrell Rebouche (Host): Owen, 318-212-4030. There you go. How's... That's the number. 318-212-4030. w- so Owen, what part isn't paid typically? I know there's no typical. Everything's a little bit different depending on your insurance. But when I look at it, I mean, what's gonna be that cash balance? Is it gonna be, a, a co-pay? Is it gonna be, a deductible?

Is it going to be something the insurance is saying, "No, no, no, we didn't agree to pay for that" on the front end that you're gonna have to fight about? I mean, how does that look?

Owen Rigby, BS, MLA: All of that.

Darrell Rebouche (Host): Okay. What's most common, you think?

Owen Rigby, BS, MLA: Like you said, there is no, normal, I guess. There-- It varies depending on the insurance and depending on your policy. But a lot of people will have on an outpatient, they'll have a copay that they'll have to pay. You know, just like if you go to the doctor and you have to pay twenty-five dollars or whatever.

It's, it's the same type, arrangement for the hospital. Then, if it's an inpatient, generally there'll be deductible and a co-- It could be a co-insurance amount that you, that you're responsible for as well

Darrell Rebouche (Host): Well, there are a lot of words out there that, you know, the average person may not really grasp the difference between a copay and a deductible, and a lot of that has to do with where you are on the calendar as well. Wendy, can you explain the basics about what a, what a deductible is and then what a copay?

I think Owen did it, but just put it for us one more time just to help emphasize that

Wendy Ward, MHA: Yes. Unfortunately, people learn about how their insurance works when they've had a hospital visit. They don't pay much attention to it before because they haven't had to. So they get really well-versed, you know, when they've had an inpatient stay or a physician visit. Your copay is gonna be when you go to the physician office.

Often you'll know that in your policy that, an office visit's only gonna be twenty-five or forty-five dollars depending on what specialty it is. the insurance on an inpatient visit's gonna be a little bit different. You have your deductible and your coinsurance as, as Owen said, but you also will become familiar with your out-of-pocket. Each insurance policy has an out-of-pocket maximum, and it's, different for every individual. your policy premium is based on your out-of-pocket, and often we'll pay a lower premium, but our deductible is high. So in the business office, we reference some of our claims as they have a high deductible, high out-of-pocket because you'll get a ten thousand dollar claim or, you know, a patient responsibility for five thousand or ten thousand dollars. That's when you become familiar with your policy. And unfortunately, these things are real. it's good to have insurance, but sometimes it is quite a burden when you have to be in the hospital for an extended amount of time. And so once again, that's when we discuss payment arrangements, financial assistance, you know, different options for our patients to make it as easy on them as possible to pay their claim.

Darrell Rebouche (Host): Yeah, that can be scary. Sometimes you just wanna talk to somebody and let them hear your story and, and work it out. So Owen, when they call that number 318-212-4030, what are the chances they're gonna talk to an actual human being on the other end of the phone?

Owen Rigby, BS, MLA: they will talk to a, to a human being They will speak to our patient service representatives. We call them pacers for short. And the pacers are-- We have an outstanding group of, of people, of pacers who, who will take care of any question that you have. They're very, very knowledgeable. If it happens that there's something they don't know, they'll go to their supervisor, come to me, come to our assistant director That's a good group of people up there, and they are, they are very helpful and they wanna help people.

So I would en- I would encourage anyone who has a question about their account, any, any question about their account from a financial perspective, to call that number 318-212-4030 and speak to one of our folks. Or they, or they can go into one of the hospitals, the acute, the acute hospitals, so North, South, Bossier, or Pierremont.

We have offices in all the hospitals, and they can go in there. The switchboard can direct, direct the patients to the, to the business office, and those ladies will be a- be able to help as well

Darrell Rebouche (Host): Okay, so don't call your cousin Randy who knows somebody who works in the hospital who can call somebody for you. Stand up for yourself.

Owen Rigby, BS, MLA: right

Darrell Rebouche (Host): So what if you have good news, Wendy? What if you have overpaid? Say something's crossed in the mail and maybe you paid a bill twice and you have credit with the hospital. How does that work?

Wendy Ward, MHA: Credit balances are worked daily, at the hospital. And often the patient will call and say, "I've received a statement and I have a credit balance," or, "I'm aware that I've paid this twice." And we will expedite those requests and get that refund processed. normally that's done within thirty days, sometimes more often than that. But we work credit balances daily. they do process biweekly and are paid out. So that-that's fluid process right there

Darrell Rebouche (Host): Well, it seems like we've kind of covered it all. We've covered insurance, we've covered refunds, we've covered redress. Owen, is there anything else you would like to say to reassure everyone that we're here to take care of you?

Owen Rigby, BS, MLA: No, just what we've already said, that we, we are here to take care of the patients. That's, you know, we are, we are in the business office. We are not hands-on. We're not at the bedside. But the way that we can help our patients is to get their, their claim paid as quickly and correctly as possible. And, and we are here for you.

And just remember that number, 318-212-4030. Call our pacers. They're, you know, they're here to h- they're here to help

Darrell Rebouche (Host): Owen has been working at Willis-Knighton for more than four decades. He was a much younger man then. Wendy has been working at Willis-Knighton for more than two decades, and they are true believers in what Willis-Knighton stands for. And Willis-Knighton stands for always placing the patient first. Wendy, would you like to elaborate on that?

Wendy Ward, MHA: We have an excellent staff in the business office, an excellent staff throughout our financial team. So please know that we are here for you always, and that we're here to take care of your needs. Again, you're in the hospital, you have health issues that you need to focus on, let us help you with the financial side

Darrell Rebouche (Host): Owen Rigby, Wendy Ward, thank you for your time. Thank you for joining us on Health on Point, presented by Willis-Knighton Health