Government

And you wonder why health care is costly πŸ€‘πŸ˜·πŸ˜·πŸ€‘πŸ˜·

My wife and are enrolled in Medicare and have supplemental coverage through an employer self-insured plan administered by a major insurance company.

Our claims go to Medicare and then are spun off to the supplemental plan administrator.

Once every few months we receive an explanation of benefits from Medicare which is several pages of information the average person has trouble understanding. Then, several weeks later we receive another explanation of benefits from our supplemental plan.

Know where it is going

Know where it is going

So, for even for a simple office visit we may receive up to twelve sheets of paper.

Today I received such a EOB from the supplemental plan. It includes five sheets of paper double-sided.

The first sheet is the mailing address and summary of the claim. The second lists details of each service including seven different message codes. The third page is information about the EOB and my appeal rights. The fourth page tells me if I need help understanding all this who to call and it tells me so in Spanish, Chinese, Korean, Portuguese, Gujarati, Polish, Italian, Tagalog, Russian, Haitian Creole, Hindi, Vietnamese, French, and Navajo.

The fifth page is a notice of non discrimination.

A great deal of this information and process is in compliance with laws and regulations.

Think of all the systems, individuals and facilities that must support all this… and this is just a tip of the iceberg.

Now I could elect to go paperless, that saves paper but it doesn’t change the processes or legal requirements… or much of the cost.

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Categories: Government, Healthcare

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3 replies »

  1. It reminds me when my father asked me what I did in the USAF once I had made it into a senior leadership role as a Master Sergeant. I told him I no longer worked on the F-15 avionics equipment, I killed trees, paperwork. LOL. Government regulations cost the economy trillions of dollars each year, most of that cost is passed on in higher prices for goods and services.
    I have to laugh sometimes when I hear tax the rich corporations they are not paying their fair share. When are people going to take a basic economics class and realize those costs are passed on to the end customer.

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  2. When I get my EOB, it usually starts off with this is not a bill with a bunch of meaningless codes and usually a denial of payment to the doctor. On the second attempt of the billing and denial, I might call to find out what the problem is. Usually the third attempt some money changes hands.

    This year my eye doctor was not paid for over 9 months and I never knew it. Had I known, I would have made few calls. Can you imagine waiting 9 months for your paycheck?

    Multiple billings and the costs of waiting or borrowing money to cover operating costs while waiting for payment has got to add to the cost of healthcare all in the name of controlling costs. I hope it is saving us money.

    The funny thing about the EOB codes is half the time BC/BS doesn’t even know exactly why something was denied. I think they just use the shotgun approach and hope one of the codes is correct.

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  3. I wrote a paper on the worthlessness of most mandated disclosures. And, the DOL worked a whole year on a model EOB. It is on the shelf over there somewhere. But, what I saw tells me it would have been a disaster – as they sat, a jackass is a horse as designed by a government committee.

    Personally, when I get to Medicare, I hope to find an open, pffs Medicare advantage option – so my EOB will be one

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