January 22, 1999

Peter Brooks has had a host of health problems over the last decade – a lung disorder, a ruptured small intestine, five bypass surgeries and a series of additional cardiac problems. After his first hospitalization at the MGH in 1986, when he was in a coma for a month because of the lung disorder, he worried not only about getting better but also about how to pay for his lengthy hospital stay.

Brooks was one of the thousands of uninsured patients that the MGH treats each year. For many years, his care was paid for by the free care pool, a program funded by hospitals, insurers, the business community and state government to help reimburse providers for medically necessary care when no other health care coverage is available.

The MGH provided $32.1 million in free care last year, making it the third-largest provider in the state following Boston Medical Center and Cambridge Hospital.

In recent years, funding for the state's free care pool reached a crisis. The private sector's contribution was capped by the state at $315 million, requiring hospitals to bear the remainder of costs – a total of $500 million in fiscal year '97. Legislation was passed in 1997 that required insurers and state and federal governments to contribute more to the pool to help share the costs of caring for the uninsured.

To better serve uninsured patients and to improve reimbursement for their care, the MGH launched a new initiative in 1998 to help these patients gain access to publicly supported health insurance programs. These programs include MassHealth, a state and federally supported health insurance plan formerly known as Medicaid, and the Children's Medical Security Plan, an insurance plan for children up to age 19.

Through the Health Insurance Access Program (HIAP), the MGH Office of Patient Financial Services expanded, increasing its ability to identify and counsel uninsured patients and help them enroll in various government programs.

"We believe that helping our patients access health insurance coverage will improve their overall health care experience," says Allison Rimm, director of the Office of the President at the MGH. "In its first year, HIAP has already been successful in connecting patients to insurance coverage they didn't even know they could receive. To continue the success of this program, we want to encourage our employees and staff to refer uninsured patients to Patient Financial Services to maximize its services for our patients in need."

Since the HIAP expansion in April 1998, Patient Financial Services counselors have helped approximately 7,500 uninsured patients enroll in MassHealth and other programs. In addition to improving services to MGH patients, the program also helps the hospital comply with a state law that requires screening of all free care patients for eligibility in other programs.

Since Brooks' first admission to the MGH, he has relied on the assistance of counselors in Patient Financial Services to have his hospitalization covered without worry for future payment. He now is enrolled in MassHealth and is one example of how the expansion of HIAP can help MGH patients. "[The counselors] have taken care of all the paperwork and applications for me," says Brooks. "They have been a wonder, helping me to take care of everything."

Patients on the main campus may visit Patient Financial Services in the WACC lobby between 8 am and 5 pm or call 6-2191. Patient Financial Services counselors also are available to patients at the MGH health centers, including Charlestown, Chelsea, Revere and Boston Evening Medical Center.

For HIAP informational materials or to schedule a presentation about HIAP for departments or physician practices, call Peggy Meehan at 6-5018.