In response to our post about our poll on the shortened window for Health Safety Net (HSN) applications, several people wrote that increasingly their clients need to submit hardship waivers and/or face bills for uncompensated medical services, even though they are likely HSN eligible. Vicky Pulos of Massachusetts Law Reform Institute writes:
YOU ARE THE EXPERTS. What's happening for you and your clients that should be understood by policy makers and advocates?
- What are the specific reasons that your clients may not get their applications submitted before the required 10 days?
- Are you submitting incomplete applications to preserve the date for your clients or does waiting for complete documentation cause you to miss the 10 day window?
Please add your experiences here...we'll make sure they are seen.
I have been following this
I have been following this string with great interest. I echo the concerns implicated in Ms. Pulos comments. Particularly her very astute question -- Are you submitting incomplete applications to preserve the date for your clients or does waiting for complete documentation cause you to miss the 10 day window? Suffice it to say, if hospitals and CHCs are waiting to have all their little duckies in a row (as repeatedly advised by the OM trainers that they should)in terms of verification before filing, then of course you are missing out on the 10 day retroactive window. My experience has been that even when all goes well, as a result of a programatic and other issues at MassHealth, the retro date on HSN is frequently inacurate (i.e. s/b 10 days prior to date of application, not when the OM determination was made). I think it folly to wait for hardship process to play out and fix when there are things that can be done much sooner under applicable regulations. The process is a pain, but if it gets the retro and patients are not stuck with bills that might otherwise be covered, then it is worth it. No? Until this issue is fixed it is better than just missing out on the retro and hence potential reimbursement.
If anyone would like a detailed explanation please do not hesitate to call.
Regards,
Dennis
Whenever your clients incur
Whenever your clients incur medical debt due to the insufficient 10-day retroactive period (or any other reason), please refer them to The Access Project for help dealing with their medical debt. My email is acohen@accessproject.org, toll-free phone number: 866-918-5232 x231. We are tracking the policy implications of this issue in addition to helping people out. I look forward to hearing from more individuals struggling with medical debt. Thanks!
The 10 day window isn't
The 10 day window isn't realistic or practical. Often times the patient is too sick or too injured to make arrangements for an appointment within that short time frame. In some instances the patient's work schedule doesn't permit time off with short notice. Documentation is not always at the fingertips of clients. I find that I am getting the client in there just to get an application in within the time frame only to have them come back w/documentation info. Faxing the documentation in requires us to wait another 10 days minimum for approval. If the client mails it in the time is often longer than 10 days and often they are told their documentation has been lost and they have to start all over again. In addition to this involving extra time on their part and ours, it puts us at risk of not getting the client back in here with the necessary documentation. Often times they don't come back because daily life problems get in their way. This also results in the MEC's wasting valuable time.
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