Patient Cost Navigation and Care – Affordability Support

Policy Statement

Well Life Medicine is committed to assisting patients in understanding and navigating the cost of their
healthcare. The clinic provides both general and individualized cost navigation services to reduce
financial barriers to care and support informed decision-making.

Scope

This policy applies to all staff involved in patient care and scheduling, including:

  • Providers
  • Medical Assistants (MAs)
  • Front Desk/Reception
  • Billing Team
  • Community Health Worker (CHW)
  • Office Manager

Policy Elements

Well Life Medicine provides the following cost navigation services:

General Cost Navigation:

  • Provides general information about services that are typically low or no cost (e.g., preventive care)
  • Supplies CPT codes, diagnosis codes, and service names upon request
  • Maintains and shares contact information for insurance carriers and cost estimator tools
  • Educates patients on potential additional costs (labs, referrals, procedures)
  • Offers lower-cost alternatives when clinically appropriate

Individualized Cost Navigation:

  • Assists patients in understanding expected out-of-pocket costs based on their insurance plan
  • when possible
  • Helps estimate costs for prescriptions, labs, and referrals
  • Connects patients to financial resources including:
    • Oregon Health Plan (OHP)
    • Prescription assistance programs
    • Community-based resources
  • Utilizes CHW services for patients with financial or access barriers

Patient Awareness:

Cost navigation services are communicated through:

  • New patient welcome materials
  • Website and patient portal
  • Staff communication during scheduling and visits
  • CHW referrals and outreach

Procedure & Workflow: Cost Navigation Process

1. Patient Entry Points

    Cost navigation support is initiated through:

    • Scheduling calls
    • Check-in process
    • Provider visit
    • CHW referral
    • Patient inquiry

    2. Front Desk / Scheduling Workflow

    • Inform patients of:
      • Preventive services that are typically low/no cost
      • Need to verify coverage with their insurance
    • Provide:
      • Clinic contact info
      • Insurance customer service numbers if needed
    • Flag patients with cost concerns for CHW referral

    3. Medical Assistant Workflow

    • During intake:
      • Identify financial concerns or barriers
      • Review HRSN screener (if applicable)
    • Offer CHW referral if:
      • Patient expresses cost concerns
      • Patient has barriers to care or medication access

    4. Provider Workflow

    • Discuss treatment options with cost consideration when appropriate
    • Provide:
      • CPT codes or service names if patient requests cost estimate
    • Consider:
      • Lower-cost alternatives (medications, labs, referrals)
    • Place CHW referral for cost/navigation support when needed

    5. Billing Team Workflow

    • Assist with:
      • General cost questions
      • Insurance coverage education
    • Provide:
      • CPT/diagnosis codes upon request
    • Direct patients to:
      • Insurance plan resources
      • Cost estimator tools

    6. Community Health Worker Workflow

    • Provide individualized cost navigation:
      • Assist with OHP enrollment or applications
      • Connect to prescription assistance programs
      • Help patients understand bills and coverage
    • Coordinate with:
      • External resources
      • Community-based organizations
    • Document all interventions in EMR

    7. External Resource Coordination

    Staff may direct patients to:

    • Insurance customer service lines
    • Online cost estimator tools
    • Community resources for free/low-cost care
    • Financial assistance programs

    8. Documentation

    • Community Health Worker interactions documented in EMR
    • Referrals tracked through Athena
    • Notes may include:
      • Cost concerns
      • Resources provided
      • Follow-up plan