The comments you make are exactly why we are dealing with
HIPAA transactions and code sets. Standards so providers and payers all
speak the same language. However, I believe I saw something in the
past about using this site in a productive manner. I would take issue with
come of the comments made in the last two messages. You are correct that
everyone wins when EOB's are clear on both the provider and member side.
Which is why I find it difficult to believe that payers deliberately
make things confusing. System limitations, budget constraints, multiple
plans with different claims determination rules, adjudicating claims fast and
efficiently through auto-adjudication, COB and many other issues come
into play in notifications that may not appear clear. I have seen
Medicare, Medicaid EOB's and the only thing more clear about them is you
see them all the time. There have been other efforts to make the
system better. DOL claims regulations requirement of certain disclosures
on EOB's are one example.
If you have issues with certain EOB's talk to your higher
volume payers and seek a productive dialogue about how things can be made
more clear. Sometimes things are complicated and there just isn't a
clear way to connect medical terminology to laymen's terms. Try to explain
to a patient why there are three different charges for one test and how each one
was paid. Sometime it is not an easy task.
>>> "Daniel E. McDonald" <[EMAIL PROTECTED]> 05/31/02 12:46AM >>> Dawn: I have worked closely
over the past two years with multiple payer organizations over the past two
years and I can assure you that the payer believes that less is better. Having worked on both sides of this
issues I feel the providers and patients suffer. Neither can communicate effectively with
each other because the Provider Summary and the Patient’s EOB have different
verbiage and numbers on them. A
provider and patient can barely discuss the financial settlement anymore because
the payers do their best to make it unclear. I saw a program on TV last night
discussing generic medications and how the big drug companies play the system to
keep the generic drugs from market so they can make more profit for their
shareholders. The payers are doing
their best to do the same with confusing the reimbursement process. I for one would invite discussions on a
national healthcare insurance system similar to Medicare that would be
controlled by a single governmental entity. Medicare pays most of our physicians
better than most of the managed care plans with less hassle! I am not one to ask for government
involvement but there has to be a better way. Who has the nice big beautiful glass
skyscrapers? The
Insurance Companies. Ask
yourself how they afford it. I no a
large payer that built their own skyscraper to spend some of those
dollars!!!! Sorry for the long
winded response but the payers do not want this reconciliation to be an easy
process. Daniel
E. McDonald -----Original
Message----- Speaking from the Provider
standpoint, physician practices are not at all pleased with the lack of depth of
information on EOBs. Major consultants are advising doctor's offices to
request that patients share the EOBs that they receive so that the doctor's
office can make heads or tails out of what the insurer is paying. When a
physician has to resort to that level to find out what they are being paid
for, that reflects pretty poorly on the insurer in both the patient's and
the physician's eyes. ********************************************************************** To be removed from this list, go to: http://snip.wedi.org/unsubscribe.cfm?list=privacy and enter your email address. To be removed from this list, go to: http://snip.wedi.org/unsubscribe.cfm?list=business and enter your email address. The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited. |
