Financial counselors at hospitals have found themselves increasingly busy

Despite her immersion in a world of sick patients without jobs or health insurance, Beth Ehlen projects unfailing cheer.

“Hi. I’m Beth,” she says, entering a room at Milwaukee’s Froedtert Hospital. “I’m a financial counselor here at the hospital.”

The patient inside, a woman in her 30s, lies in bed, not resting. She shifts around trying to get comfortable.

Her face tightens. Her eyes pinch shut.

“Would you rather I come back at a different time?”

The patient is simply not up to talking, and Ehlen resumes her rounds. Although they haven’t spoken, she knows this: The woman is uninsured, an all-too-common predicament in an era when millions of Americans are out of work and health care reform has only just passed.

A year ago, Ehlen and the other Froedtert counselors were making 900 to 1,100 visits to uninsured patients each month; now they make about 1,200 to 1,400 visits.

“We have more patients who have lost their jobs,” says Jennifer Underly, the hospital’s manager of patient financial services. “We have more patients who don’t qualify for government programs.”

When these patients arrive at the hospital, Ehlen says, “They are scared and they probably are seeing dollar signs.”

In the room she has just left, this is indeed the case.

When Ehlen returns an hour later she learns that the patient, Gina Johnson, is a 37-year-old nurse and single mother with two children, who moved back to Milwaukee a week earlier from Minnesota.

She moved because her family lives in Milwaukee and her nurse’s salary wasn’t enough to afford a three-bedroom apartment in St. Paul and day care for her 5-year-old daughter, Jaidee.

Johnson is looking for work, but the throbbing and spasms in her abdomen have made it impossible to focus on anything else. The pain radiates to her back. It hurts so much that she had been reduced to lying on her sofa crying, trying to hide the tears from her children.

As a nurse, Johnson knew she should have gone to the hospital weeks ago. She was afraid. The last time she went to the hospital in Minnesota, her stay lasted six days and the bills were steep. She had health coverage then.

“This was my first time without insurance,” she would say weeks later. “I was thinking, ‘How am I going to take care of this?’ ”

Problem won’t disappear

It’s a question we’ve wrestled with as a nation. And while health care reform may offer more direction, it is not likely to remove the need for financial counselors like Ehlen, at least in the near future.

“I suspect over a long period of time the number of financial counselors will decrease. In the near future they will increase because we will have all of this paperwork,” says Thomas E. Getzen, professor of risk, insurance and healthcare management at Temple University’s Fox School of Business.

Getzen stresses that once health reform kicks in, it won’t bring about universal coverage. The Congressional Budget Office estimated that the reform legislation will lift about 32 million people from the ranks of the uninsured, “leaving about 23 million nonelderly residents uninsured, about one-third of whom would be unauthorized immigrants.”

Among legal residents, the percentage of insured would rise to about 94 percent, from around 83 percent now.

“You could have universal insurance, but the most difficult-to-cover patients will still be difficult to cover,” Getzen says, listing the homeless and drug-addicted as two such groups.

Come winter, for example, hospitals receive homeless men and women suffering from frostbite and other ailments, patients who arrive with little if any identification.

“You’re still going to need people to get them into the system,” Getzen says.

Prior to the reform vote, much discussion centered on the cost of hospital care for the uninsured. Hospitals often cite the amount of uncompensated care – the sum of a hospital’s bad debt and its charity care – though critics suggest these numbers can be easily inflated.

“There is no such thing as a fair estimate of the cost of health care,” Getzen says. “There is the cost of running the whole hospital, but there isn’t a cost for this individual patient. You can only estimate it.”

Froedtert says it provided $30.9 million in charity care or financial assistance in 2009, compared with $7.3 million in 1999.

Witness to the uninsured

James, one of the uninsured patients Ehlen meets on her rounds, has come to Froedtert because of a bleeding ulcer.

“I maybe waited too long because I didn’t have insurance,” says the 42-year-old man.

“I didn’t want to put too much (financial) pressure on my dad. When I started throwing up blood, money was not an issue anymore.”

Ehlen says she will check on James’ application. Meanwhile she gives him the application for the hospital’s charity care program; Froedtert prefers the term “financial assistance” because some patients are put off by the idea of accepting charity care.

Although fear and worry are common among patients forced to make a hospital visit without insurance, Ehlen does not find her work depressing. She is heartened by the human relationships she sees, the husbands and wives who are there for each other in a time of need, the adults who become parents to their own elderly parents.

Two months after Ehlen opened the door to Gina Johnson’s hospital room, Johnson is back at her apartment in Milwaukee. She has pain medications that have eased the discomfort in her abdomen. She has found a nursing job, too.

With Ehlen’s guidance, Johnson applied for a state program for adults with dependent children. She also learned of health care clinics that charge on a sliding scale for those who are financially strapped.

“She left me in a way feeling this isn’t going to be so bad,” Johnson says. “There are some options out there for me.”