If insurance is the first question your contact team asks a family calling about hospice, it tells that family exactly what your organization values most.

I want to ask something directly to every hospice operator reading this:

When a family calls your organization for the first time — frightened, exhausted, often in the middle of a crisis they didn't see coming — what is the first thing your contact team asks?

If the answer is insurance, I understand why. Reimbursement is real. Eligibility matters. The organization has to be able to sustain the care it provides.

But the family on the other end of that call doesn't know any of that. What they know is that someone they love is suffering, that they don't know what to do, and that they just worked up the courage to ask for help.

My team was trained differently.

The first conversation was about why hospice, why now. Recent changes in the patient's condition. Symptoms the family was witnessing and didn't have words for. What they had been told about hospice — and more importantly, what they believed about it that wasn't true.

The goal was to meet them where they were, at all cost, and navigate every barrier between that family and the care their loved one needed.

And yet there is one barrier that has always troubled me more than any other. The patient could be curled in pain. Experiencing active mottling. Hours or days from a peaceful transition — and we are on hold with an insurance carrier trying to establish eligibility.

What makes it worse is what families do when they sense the hesitation.

They try to help. They call the insurance company themselves. They gather documents. They wait for callbacks. They spend the final days of their loved one's life navigating a system they were never equipped to navigate — because they wanted to remove the obstacle so the care could begin.

And some of them wait too long.

This is the cost of a system where reimbursement precedes the human. Not because anyone intended it that way. But because the operating model was never designed to hold both things at once — the urgency of the patient and the necessity of the process.

To every hospice biller who has ever sat on hold — call after call, system after system, searching for any crumb of evidence that reimbursement is possible so that care can begin:

You are the reason patients who almost didn't make it through the insurance barrier got there anyway. You are not in the room when the family exhales. You don't see the moment the pain is managed for the first time in weeks. But you are part of why it happened.

This work sees you. And it is grateful.