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Why the American Public Needs Insurance Advisors in Hospitals

Erin Hughes

Auburn University at Montgomery

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Why the American Public Needs Insurance Advisors in Hospitals

Twenty-nine million Americans in 2017, or 9.1% of the American population, were

medically uninsured (CDC, 2018). The number of medically uninsured individuals in the United

States has lowered substantially in the past eight years, since the implementation of the

Affordable Care Act. This number could be lowered further through access of a hospital

insurance advisor who may be easily found by the public. Hospitals must provide insurance

advisors to increase insurance literacy, increase the number of the medically insured, and

increase quality of care.

Individuals with low levels of health insurance literacy are less likely to become insured

than those who have a higher level of insurance literacy, which can be increased through

speaking with an insurance advisor. Those with low health insurance literacy levels need an

advisor with proficiency in the medical and legal jargon used in insurance documents. Levitt

(2015) found that only 64% of adults without insurance were aware of monthly premiums. Lack

of understanding of health insurance can lead to mis-use of plans. For example, Levitt’s study

shows that only 53% of uninsured adults could define a provider network. Without knowledge of

a provider network, an individual could use a provider outside of that network and accrue extra

fees. Lack of knowledge about the process of application, requirements for eligibility, and

monthly or annual dues can lead to people not applying for the right kind of insurance and being

denied. Access to an insurance advisor in a hospital will allow for education of those with low

health insurance literacy, which will increase the number of insured people.

Public access to an advisor who increases health literacy will help decrease rates of

uninsured by presenting to areas that are frequented by those without health insurance. Sentell

(2012) found that people without insurance are more likely to present to an emergency
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department with non-emergent symptoms. Those without insurance in the emergency department

will have the convenience of an advisor readily available to discuss their individual insurance

needs. Insurance advisors in a highly populated, public area leads to greater rates of insured

people due to convenience of access for those without insurance who frequent the emergency

department for symptoms that can be cared for by a primary care provider.

Individuals who use the emergency department for non-emergency problems need access

to primary health care providers. Bodenheimer and Hoangmai (2010) found that many providers

may refuse patients based on lack of insurance. One single primary provider will become

familiar with the individual over time and prevent changing medication regimens or courses of

treatment due to seeing different emergency physicians. Having a primary care provider and

routine screenings readily available leads to a higher overall health rating. A higher health rating

leads to fewer chronic diseases and fewer emergency visits from exacerbations of chronic

diseases (Bodenheimer & Hoangmai, 2010). The authors further state that a routine provider will

also lead to higher health literacy levels from education about risk factors and disease processes.

A hospital insurance advisor must be readily available to assist those who may be unsure

about health insurance application processes, eligibility requirements, and benefit plans. Once

the advisor explains different benefits and application processes, the individual will be able to

choose insurance that properly fits their needs. An insurance plan that fits individual needs along

with a basic understanding of provider networks and deductibles will allow for those who were

once medically uninsured to use the plan to their benefit to obtain health education and routine

care. Insurance advisors in hospitals will lead to higher insurance literacy levels, rates of the

medically insured, and overall health ratings.

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References

Centers for Disease Control, U.S. Department of Health and Human Services (2018). Health

insurance coverage: Early release of estimates from the national health interview survey,

2017. Retrieved from https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201805.pdf

Bodenheimer, T., & Hoangmai, H. (2010). Primary care: Current problems and proposed

solutions. Health Affairs, 29, 799-805. doi:10.1377/hlthaff.2010.0026

Levitt, L. (2015). Why health insurance literacy matters. Journal of the American Medical

Association, 313, 555-556. doi:10.1001/jama.2014.1741

Sentell, T. (2012). Implications for reform: Survey of California adults suggests low health

literacy predicts likelihood of being uninsured. Health Affairs, 31, 1039-1048.

doi:10.1377/hlthaff.2011.0954