Listening to members helped Premera improve EOBs


I'm one of those kinds of people who barely scans instructions before jumping right into the task at hand, whether it's assembling new furniture or learning how to operate my new smartphone. Sure, I usually run into snags (many, many snags) along the way, but I just can't be bothered to put down whatever is in my hand and pick up those long, wordy and oh so tedious instructions. I'd rather fumble my way through, thank you very much.

So you can imagine how closely I inspect my explanation of benefits forms when they arrive in my mailbox. Often, they show up weeks or months after the medical service occurred, and this mama's brain often doesn't remember that far back--about anything. Even if it did, that boring document never grabs my attention. I certainly don't feel like reading through to verify its accuracy, let alone digest all that insurance jargon.

This admission is coming from someone who closely watches the health insurance industry, reporting on insurers' every move and constantly educating myself about industry changes coming down the pike. I know how important those EOBs are, but I still don't want to invest the time to read them.

So how can we expect individuals who don't think about the health insurance industry on a daily basis, barely know how the reform law affects their coverage and don't know the industry-specific lingo to sit down to read and, more importantly, actually process these EOBs?

Premera Blue Cross thinks it's reached a solution to help the typical healthcare consumer better understand and manage their insurance coverage. The Washington state-based insurer recently simplified and reorganized its EOB with the consumers in mind.

"The goal was to make our EOBs easier to read, understand and use for our members, while still abiding by EOB requirements," Amy Carter, Premera's senior communications manager, told FierceHealthPayer.

"We are always asking our clients and members for suggestions on how we can serve them better," she said, adding that in this case, Premera's members wanted an EOB that was "easier to understand and digest." So the insurer took its members' EOB-related comments, opinions and recommendations and--lo and behold--actually improved an otherwise dreadful product of the insurance industry.

Premera's revised EOB now consists of 3 parts--claims summary, glossary and claims detail. The claims summary, Carter said, now explains healthcare costs in "simple math," clearly explaining how much members owe and how much they saved. The glossary is a newly added section that, you guessed it, defines common terms used throughout the EOB. And then the claims detail section has been redesigned to clearly show members their plan discounts, payments made and any remaining financial obligations still outstanding.

Another great option, especially for minimalists and environmentally minded people like me, is that members can now choose to receive EOBs electronically. It cuts down on unnecessary paper and helps keep your house clutter free. Plus, it saves Premera from printing and mailing all those EOBs. Win-win!

"The simplified EOB is just one step Premera is taking to become a healthcare partner with our customers in order to give our members the tools they need to make smart healthcare choices," Carter said.

I commend them for seeking advice, listening to their members and acting upon recommendations receive to improve the EOB document.

But it doesn't even end there. Premera has included a short survey on all information materials related to the new EOB, asking members to provide feedback about the reorganized document. In only over one month, Premera already received more than 70 responses, of which 70 percent said "they found the new EOB useful," Carter said.

"And a number of people have commented that it is much easier to understand. One member shared that the new EOB 'is well laid out and it is easy to find the amount paid and the amount I still owe the provider,'" she added.

Thank you, Premera, for being open and available to hearing your members' suggestions and actually taking steps to meet their requests. Well done. - Dina (@HealthPayer)