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Somebody, please, fix the broken healthcare payment system


I've written about this issue before, but it bears repeating: The health insurance industry must do something about its payment system.

Let me paint you a picture that's indicative of the problem: In January, I visited a doctor, who advised me to undergo some routine blood tests. In February, I received a bill for that doctor's service. Then in March, I received a bill from the lab that performed the blood tests. And then--a whole four months later--another bill arrived from the same lab for a separate amount.

My health insurer paid for some of the costs, but not all (which was expected based on our health plan). However, the process had a couple of problems, as I see it. First, it processed some of the claims a couple of months after the services were rendered. Then it took another several months to process the rest of the claims.

I'm well-versed on the ins and outs of health insurance and its reimbursement system. And I know all too well about the unnecessary hurdles that consumers sometimes have to jump through in order to understand their medical bills.

But I still felt burdened by the steps I would have to take to determine what exactly I owed. Not to mention the time I had to spend on the phone with the doctor's office, lab and insurance company to figure out the actual amount that I owed to each of them.

I doubt I'm the only consumer in this situation. That means consumers are receiving multiple bills even though they rightfully assumed they already took care of their financial responsibility.

I eventually sorted out the murky details and wrote a few checks. But when final payments are made in September for services provided in January, the problem seems all too apparent. Communication among insurers, providers and members is woefully lacking. Providers billing for services rendered and insurers paying for those services well after they're delivered leaves consumers in a financial quandary.

Based on my experience, for example, I may feel compelled to reach out to my insurance company every time I receive a bill from my provider just to verify whether (and how much) they already paid. That's not a responsibility I want--nor should have--to take on.

What's more, in today's post-reform market where consumers can select their insurers through the health insurance exchanges (and aren't reliant upon employers' choice of insurance plans), these types of nuisances can mean the difference between a satisfied member who renews coverage and a dismayed member who looks elsewhere for healthcare coverage.

And that's why I'm imploring insurers and providers alike to improve their communication and coordination of claims and billing. Please don't force the issue onto consumers, who then have to take matters into their own hands. And given that so few consumers adequately understand industry jargon, that job is even more challenging for most.

There has to be a better way. I hope the industry finds it soon. - Dina (@HealthPayer)

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