My patient can’t continue to pay for treatment. What’s a provider to do?
In this age of uncertainty around health care, we are confronted by the sad reality that patients may run into difficulties when their insurance or other form of coverage will no longer pay for the services we provide at Kennedy Krieger Institute. This is especially difficult when we have established relationships with children and families. Whether we focus on “doing good” or “avoiding harm,” these situations are fertile ground for ethical conflict.
So, what can we do?
Members of the Institute’s Ethics Program recently reviewed options during a departmental ethics consultation during which this concern was raised. During consultations, program members develop a range of ethically permissible options. After careful review and discussion of this issue, program members agreed upon several options, including:
For individual situations involving financial hardship:
Assess risk. Departments should have procedures in place in which the provider is asked to provide input about the risk of ending or transferring services for a patient. Appointments should not be cancelled due to financial reasons without first contacting the provider for his or her assessment.
- The provider or program should look for ways to minimize risk. For example, consider reducing the frequency of services so that a patient can still be seen.
- Explore other options for continuing services or referring out for covered services.
Provide patients and their family members with options that would allow them to continue receiving services from their Kennedy Krieger providers. Kennedy Krieger has policies and procedures in place to assist families with financial arrangements. Information about these policies and procedures can be accessed through Patient Accounting. Staff members of the Finance Department may work with the family to meet its needs. Additionally, the Care Center may work with insurance providers to discuss options for covering services or may give the patient and his or her family members information so that they may work with the employer through which the patient has health insurance to try to get the insurance carrier to cover the needed services.
For hospital, program or departmental consideration:
Develop protocols regarding how to help manage situations of financial hardship, including accessing clinical input on risk.
Seek and spread educational information about financial assistance programs at Kennedy Krieger via trainings, staff meetings and other forms of distribution to clinical and administrative staff members.
Together, we can work to ensure that our patients get the treatments they need despite the rough seas they may face.