Episode 14: How to master the benefits investigation process with Keny Urbina

Transcript: How to master the benefits investigation process with Keny Urbina

Dylan McCabe: WeInfuse podcast episode number 14. Welcome to the podcast, my name is Dylan McCabe and each week we give you a behind the scenes look at the infusion practice and our goal is to take the confusion out of infusion. So we interview industry experts and people in the trenches with infusion practices, from providers to front desk, people, to people across every end of the spectrum and I’m really excited about this episode because we are going to interview Keny Urbina and she is an overseer of a very large rheumatology practice in North Jersey and she is in the midst of the most cumbersome part of the process, which is the benefits investigation process. I mean, that’s where you’ve got the most moving parts. It’s where the costliest mistakes can get made and she is passionate about it and I think you’re really going to enjoy this interview with Kenny let’s jump right in. All right. Like I said, we have a special guest on the show today and that is Keny Urbina. She oversees a large six physician infusion practice in the North Jersey area and she has a lot of experience really doing all the things you need to do leading up to the infusion, making sure that patient is ready to go with all those pre-authorizations referrals, all of the dotting all the I’s crossing all the T’s and overseeing that whole process to get the patient access to those amazing life changing therapies. So Kenny, thank you so much for being on the WeInfuse podcast.

Keny Urbina: My pleasure, thank you for having me.

Dylan McCabe: Absolutely and so I know I gave a little brief overview and I know that you and I have gotten to talk at different conferences, we’ve had some collaboration offline and it’s been really neat to hear your heart and your background and you write a blog as well, right?

Keny Urbina: I do, it’s called Making Rheum and it’s basically about my journey through rheumatology. It’s very exciting, it’s recent so I’m still just at the beginning and it basically just talks about what goes on in different practices. So I have guest speakers that give me their day to day. It’s pretty fun I would say, very fun.

Dylan McCabe: That’s great. I mean, hey, that could turn into a podcast. That’s great though and we’ll definitely want to tag your information for how people can get in touch with you at the end of this podcast, but it’s our whole goal to just take the confusion out of infusion and interview people like you who are in the trenches, who are just living that life of getting these patients access to these life changing therapies and I I’m really glad we have you on the show because we get calls every day from practices either struggling and they need help with their infusion practice or we get a lot of calls from people that want to start an infusion practice and your role is the main issue that we focus on is what is your process going to look like managing benefits, investigation and all that stuff. So before we get into all of that, I know you’ll have a lot of great things to share there. Why don’t you fill in just kind of your background story, how you got into infusion therapy, just kind of your journey up to this point for our listeners.

Keny Urbina: Okay. Sure. Well I’ve been in the practice for about 10 years. I started as a receptionist and I kind of got the job because I was going towards my bachelor program in biology and then I realized that I loved working there. Then throughout the years I learned a little bit of billing and then coding then authorization. So I felt like I was learning and growing into practice and I knew that that was the place where I wanted to be and then finally I hit a department which is infusion therapy and I realized that that’s where I wanted to say I felt like authorizations and talking to insurance companies and then talking to the patient, being the middle person was something that I enjoyed and understanding what the insurance company was telling me so I can tell the patient and explain it to them and then ultimately help them get better. I knew that that was what I wanted to do and I’ve been there ever since.

Dylan McCabe: That is so interesting; now for some people listening and for people already in infusion, the first thought that comes to my mind is some people say that’s the part that they hate the most. I mean, they can’t stand talking to insurance companies. So tell me why is your heart behind that? Why do you love that part of the business?

Keny Urbina: Honestly, it’s the insurance company they’re reading a script. Most of the time, the people that I speak to are not even in the United States and I go into the call knowing that I may not get someone here in the United States. I speak to people in the Philippines, in Mexico in just honestly India even sometimes. So my goal out of the phone call is to get the information and make sure it’s accurate and then translated in a way where I can explain it to the patient. So for me, extracting the data and then converting it into a way where someone can understand what they’re trying to say. That to me sounds like fun, a little weird, but fun.

Dylan McCabe: It’s clear that you you’re offering such a level of customer service to the patient, which they may not be getting in other places and if it’s confusing to you or difficult for you to extract that information and put it in language you can all understand, we know it’s hard for the patient and that’s just great that you play that kind of middleman role to help the patient as they navigate a cumbersome process. That’s great.

Keny Urbina: I say the more complicated the insurance, the better because honestly it’s weird, but I enjoy it when it’s complicated sometimes because then I get to fix it. So to me, it’s like, I go in knowing that there may be an issue and it’s like, okay, how do you fix it? So that’s why I enjoy problem solving.

Dylan McCabe: That’s great. Yeah, that’s the first thing that came to my mind is problem solving. So you probably have strength in that area of solving problems and resolving issues and then also helping people at the same time. So that’s great, I love that you shared that because it is rare to hear that perspective and that’s clearly a healthy, positive patient centered perspective and I just love that you shared that. So what would you say out of all the things you do, I know that you have a lot of balls in the air with all the patients and with each patient, there’s quite a process you have to move them through from beginning to end. So what would you say today is your main area of expertise?

Keny Urbina: I would say it’s finding help for the patient. Throughout the years, the insurance company and the coverage has changed and a lot of patients have not been able to get the treatment that they require due to higher premiums. So being able to get the patient onto the correct treatment, I think that would be something that I care the most.

Dylan McCabe: That’s so great and I know there are a lot of technical things you could have mentioned in a workflow process. You could have mentioned you didn’t go there. You went straight to helping the patient and I find that a lot of the people we interview on here, whether it’s nurses or people in operations, it’s typical for people to be patient focused and you have a lot of passion, I’ve met you in person a few times and you always come across very passionate and excited about what you do and I think that’s where that passion comes from. It comes from a desire to really help people. So what would you want out of all that, what’s one big thing you would want our listeners to take away from your experience in this practice?

Keny Urbina: Honestly, patience and to be understanding of our patients, a lot of the time they don’t know what their plans are. We can’t expect them to know what their deductible is, who their carrier is. A lot of the time patients just come in and they bring you five different insurance cards; it’s like pick a card, any card. So we need to be able to take that weight off of our patients, especially because a lot of the time they don’t know if their insurance changes. We had a patient who got enrolled into an insurance company. She didn’t sign anything. She wasn’t aware the insurance company took her silence as an agreement. So she came into our office with all these insurance cards and finding out which one was the actual insurance. Yes, it was a puzzle but now the patient is aware. I was able to put a sticky on the back of a card that said, this is my insurance, so something as small as that can change her care or their care in general. So I was just saying, being patient with our patients will bring more patients because they will tell their friends you know what? This practice really cares about me and they sat down with me, they explained to me my benefits in a way where I can understand and they went that extra mile. That to me is very important and informing, customer service is a huge, huge part of this industry and I’m glad that I’m able to help as many people as I do.

Dylan McCabe: Well, it is so helpful. I mean, my wife works for a large health system here in the Dallas, Texas area and it was the year for enrollment to renew your insurance plan but of course, there are always new plans coming out and they had a huge meeting about it companywide and she attended one of the meetings and they basically came out with another plan that was a little cheaper. To sum up, they basically said, you’re going to notice minimal changes, everything changed. We got on this new plan, all of a sudden beforehand; we could go straight to a specialist. We never needed any referrals from our primary care physician. All of a sudden we needed a referral. We also couldn’t go to our typical doctors we were used to going, they were all of a sudden out of network. It was just a mess and I told my wife, we’ve got to get back on our other insurance as soon as possible, especially when you have little kids in the mix too. So I just know from that side of it, how frustrating it can be as a patient and the insurance companies, like you said, don’t make it easy. So that’s just great. So, well, let’s go into a different part of this. Clearly you have a passion for this, you’re helping people get life-changing therapies, but we all know that in the infusion practice, there are amazing success stories of people’s lives who are changed. There’s also a huge struggle, some of those struggles are financial mistakes that get made in the practice. There are struggles with workflow, there’s all community, it’s a business as well as a practice. So what would you say has been one of the biggest challenges that you face? Give us kind of a behind the scenes look at that.

Keny Urbina: Let’s see, the struggle I would say is communication between the patient and our office. I would direct the communication to go towards like what insurance they have. A lot of the times patients bring in their pharmacy insurance and their medical insurance and they don’t know which one to give and then we run the benefits under the wrong insurance and then the patient calls, she’s like what happened to my treatment and when the patient and the practice don’t have a great communication, it delays treatment. This happened to one of our patients who has Medicare, but her husband was working. So she gave us two insurances. She didn’t tell us that her husband was working and that her Horizon insurance was primary. So we ran all the benefits through Medicare and Horizon as a secondary and we confided the information to, it’s the company that runs the benefits, the pharmaceutical companies have companies that check on the benefits and they give you a breakdown summary. So we sent the patient’s insurance, we got the breakdown and the company gave us the incorrect benefits. They said the patient’s Medicare was primary and the Horizon was secondary. So we ended up infusing the patient and then the insurance didn’t pay because it wasn’t in the correct order. So things like that can cost the practice. So luckily we were able to appeal and get it paid. But imagine if we wouldn’t have caught this error, it could have cost the practice thousands of dollars. So I would say communication is key and knowing your patient will not only help you, but it will make a huge difference in their lives.

Dylan McCabe: That’s so good and managing that communication flow from the patient to you, and then from you to the different either pharmaceutical hubs like you described, or as payer hubs or whatever, just managing that whole process is obviously why we created WeInfuse. But that’s just so good that you bring that out because a lot of people, I heard from a physician today, it was actually a gastroenterology physician part of a huge, I think 37 physician group, and they want to start an infusion practice. And told him from the get go, do you have any experience running an infusion practice and he said, no and I said, well, we have a lot to talk about because it’s a very complicated workflow and you definitely want to do it the right way and build a strong foundation. So anyway, we’ve got multiple meetings scheduled with them to help them start their infusion practice. But out of all that, I mean, what’s one key takeaway, one tip or tactic that you could offer as advice to our listeners on that?

Keny Urbina: I would say when it comes to insurances, make sure to sign up for newsletters, check on their bulletin boards, they constantly change policies and a lot of the times they’e not going to call you and say, hey, we dropped this medication or we added step therapy. So have a binder or put a bookmark, do something that will help you track the main insurances that you deal with. So you know this medication needs step therapy with this insurance but not with the other insurance, it’s like a game of Sudoku, basically. Everyone is changing therapies, but one might pick it up, one might drop it. So knowing the bulletin policies will help you as well as knowing the foundations out there and when they open funds, what type of medications they’re willing to help you with. It’s all about outreach and knowing what’s going on in your state.

Dylan McCabe: That’s so good. I love that. You mentioned newsletters too, and that’s a proactive mindset. I mean, let’s face it, a lot of people, no matter what their job is, they don’t find passion or purpose in their role and they don’t do this kind of stuff. They aren’t proactive. They aren’t thinking ahead, trying to be strategic, trying to constantly offer value. But I like your story because you started out as a receptionist, then you learned more skills, you got into coding and now you’re managing one of the largest practices in North Jersey, as far as the infusion side, which I would say is probably the biggest revenue generator in that practice and I think that’s great that you’re being proactive to think ahead about how to stay on top of this process.

Keny Urbina: So it’s all about just getting the resources you need and I know NICA has great resources that I utilize myself. Honestly, that’s the only way to stay on top is to just sign up a newsletter and get the resources that you need.

Dylan McCabe: Absolutely and for those of you listening, she mentioned NICA, that’s NICA, that’s short for the National Infusion Center Association, which is a non-profit and it’s their purpose is to provide patient access to these incredibly expensive biologics and also equip people and provide resources and stuff like that and they’re actually having their first annual event at the, at the time of the recording of this podcast, they’re going to have their first annual event coming up in the summertime. You can check out their website, infusioncenter.org to find out more about that.

Keny Urbina: Very excited to go well, I will see you there.

Dylan McCabe: Yeah, we will, we’ll see you there. Well, let’s go on to another question here. You’ve talked about your passion, your process, you’ve talked about one of the biggest challenges you faced as well, or do face on a daily basis. Tell our listeners this, what are you most excited about right now in your infusion practice?

Keny Urbina: Honestly, just growing we are getting more physicians to come join, which is great because that means we’ll be able to help more patients. We are very busy right now. So trying to get an appointment may be a little tough, but we’re solving the problem by adding new physicians. So that’s always very exciting and I can’t wait to get to know new patients.

Dylan McCabe: That is exciting. Part of something that’s growing, part of something that’s changing, that is enjoyable because you have to stay on your toes and move and change along with it. So that’s great. So well with what you’re studying, what you’re learning and receiving newsletters and being proactive, what would you say are maybe one of the hottest, maybe one or two hot topics that are the things that are happening in the infusion space today?

Keny Urbina: I would say it is the Medicare advantage plans, I’ve seen them come up a lot. There is like the Cigna Medicare plan, the Aetna Medicare plans and here in New Jersey, they have Colver plans. These plans have lower premiums for our patients. However, they have a large out-of-pocket. So patients sign up for these insurances and then they realized that they made a mistake. So I would like to just share the information that if your patient is in need of any therapy, let them know that these advantage plans may be less expensive for the premium wise, but they will be spending money towards the out of pocket if they decide to go on therapy. So I definitely tell every patient that I have, if you have a long-term condition, stay with your Medicare and your supplemental, try not to go to advantage plans because it’s tough to find help for those types of patients it can be done, but it’s just tough.

Dylan McCabe: That’s really good to know. So, I mean, that’s something I didn’t even know about because I don’t stay up to date enough on what’s happening with Medicare. So that’s great. Now, do you have a website or a resource that you go to, to stay on top of Medicare issues?

Keny Urbina: Honestly, I kind of just use different websites. I use the actual Medicare website and then I use Health Well Foundation, they give me updates. I use NICA as well for updates and I’m just on top of the bulletin boards. I have a binder of all the insurances and their tabs and their infusion therapies and what they allow, what they don’t allow. I have an Excel sheet, I’m prepared to just combat the insurance world.

Dylan McCabe: That’s great. Well, out of everything that you’ve learned and experienced so far in the infusion space, what’s one last parting piece of advice for our listeners?

Keny Urbina: I would say you don’t know until you ask. So if you run into a problem with getting coverage for a patient, talk to your reps and see what they can do to help you. I utilize my reps so much that I think they’re tired of me. I call them when I run into a problem, how they can help me. There’s different programs that pharmacy companies have that you can get your patients in, whether it is an uninsured program or a foundation, they will help you. So I would say utilize your reps and know what type of programs are out there.

Dylan McCabe: That is so good. That’s very, very helpful and so before we go, I’d love to share with our listeners how they can get in touch with you or read your blog, how can we learn more from you?

Keny Urbina: Well, you can definitely reach me through my blog, which is www.makingrheum.com and there I put little blog articles about what goes on in different practices and I mentioned that I had guest bloggers. I also have some resources there that will be able to help in terms of infusions or other little quizzes to just keep you on your toes.

Dylan McCabe: Oh, that’s great, so makingrheum.com

Keny Urbina: Right and that’s R-H-E-U-M.

Dylan McCabe: R-H-E-U-M. Okay, great, like rheumatology makingrheum.com. That is so good. Well great because there’s not a lot of people like yourself that are commenting on this. I mean, we’re the only podcast talking about infusions and you are one of very few bloggers out there and getting guest writers on and so forth. So I just think that’s great. So makingrheum.com and that was our interview with Kenny and thank you so much for being on the show.

Keny Urbina: No, thank you for having me. I enjoyed our little conversation. It was great. I hope that I’m able to help those who are listening and help our patients in the long run because I definitely have a soft spot for them. So if I can help, I will do it.

Dylan McCabe: That’s great. Well, thanks again.

Keny Urbina: No problem. Thank you.

Dylan McCabe: All right. That concludes the podcast with Kenny and I love what she communicated. I mean, she clearly communicated a passion to help patients and that gave her such a purpose each day. It causes her to go above and beyond typical job requirements and I just love her passion for her patients. She loves connecting the dots for patients. She loves helping them navigate the tricky process as things she used the word picture of putting the pieces of the puzzle together and that was just so great. She also mentioned resources staying on top of the situation remaining proactive means that she taps into resources like newsletters, blogs and going to conferences. She also mentioned going to the NICA conferences in the future at the time of the recording of this podcast anyway, if you’re just listening to this as it’s just come out and then she also mentioned her own blog that she writes makingrheum.com, R-H-E-U-M, short for rheumatology. I’m actually looking at her website right now. It’s very well done. She has great resources and insights and tools, and it was just a really neat, `creative website. So be sure to check out makingrheum.com. Well, guys, I hope that took a little bit of the confusion out of infusion with this latest episode where we interviewed Kenny, if you haven’t done so already be sure to check out our website as well, weinfuse.com and if you haven’t seen a demo of our software and the powerful features it has specifically for the infusion practice, be sure to go to weinfuse.com and request a demo and someone from our sales team will follow up with you and get that scheduled. All right, guys, excited to be on this journey with you. This is another episode of the WeInfuse podcast and I will catch you in the next episode.

Guest Speaker: Keny Urbina, MBA, PACS, currently serves as a Board Member for the National Association of Medication Access & Patient Advocacy (NAMAPA), and is a Field Access Specialist for Immunology at AbbVie. She received her BS in Biological Sciences from William Paterson University; Master’s in Business Administration with a concentration in Healthcare from Capella University; and Doctorate of Health Administration, Healthcare Policy and Advocacy from Capella University.