Author Question: The patient in the ambulatory clinic asks the nurse in the billing office, Why do I have to pay ... (Read 45 times)

wrbasek0 · **on:** Jul 23, 2018

The patient in the ambulatory clinic asks the nurse in the billing office, Why do I have to pay 10.00 for this visit when I have insurance? What is the nurse's most appropriate response?

a. I don't know how your insurance works. You need to pay this and follow up with your insurance company.
b. This a co-payment you are required to pay per clinic visit as described in your insurance plan.
c. Healthcare is expensive and insurance companies can't pay all of the costs.
d. This is part of your insurance premium that you pay monthly.

Question 2

The 75-year-old patient is preparing for discharge and tells the case manager, I don't know what I am going to do when I get home. I cannot afford the medications the doctor has ordered for me.

What is the case manager's most appropriate response?
a. We can have a social worker see you when you get home.
b. Medications are expensive, but you will need to take them.
c. I can speak with your doctor about discontinuing some of the medications.
d. The home health nurse will address this when she sees you.

cclemon1 · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

B
Those who have insurance or government-financed insurance bear some of the expenses of healthcare through cost sharing. Typical cost sharing can be in the form of co-pays, deductibles, paying a portion of one's insurance premium, or paying costs above a fixed payment amount. Patients do not always understand cost-sharing methods and may need an explanation at the time of the visit. The best response is for the nurse to explain what a co-payment is. Most facilities have access to the coverage plan and can answer immediate questions until the patient is able to follow up with his or her insurance company. Stating that healthcare is expensive is merely stating the obvious; it may also be perceived as defensive rather than supportive. Co-payments are typically not part of an insurance premium and are only collected at the time of a service.

Answer to Question 2

A
Social workers counsel patients on financial, housing, marital, and family issues affecting healthcare. Owing to rising healthcare costs and diminished access to healthcare, particularly for aging populations, social workers are increasingly used to help move clients through the health system. Acknowledging the rising costs of medications does not assist the patient in solving the problem of his ability to pay for medications. The case manager cannot make any assumption that to alleviate the patient's concern for affording medications, it might be appropriate to have some medications discontinued. The home health nurse typically coordinates the care and services but is not typically the healthcare provider addressing financial concerns.