Anthem VP: Healthcare billing system is broken

Billing process causes so much confusion that patients say they aren’t 100 percent sure what they owe until the collections agencies call. Providers and payers must band together on smarter benefit design.
By Beth Jones Sanborn
09:34 AM

“I just wait for the letter from the collection agency -- then I know I should pay.” 

David Krause, Vice President of the Business Improvement Group at Anthem has heard a variation on that theme numerous times. 

“That’s how broken it is. That’s true,” Krause said. “That statement came up in every focus group, some version of that statement.”  

He said it’s not that people don’t want to pay their medical bills, it’s that the billing process causes so much confusion with multiple bills and statements that people say they aren’t 100 percent sure what they owe until the collections agencies come knockin with the final total.

The bottom line? Consumers are confused about what they owe. In fact, Krause says, the most common reason for calls to a national health insurance carrier is clarification on billing. 

“Providers and insurers need to work cohesively together to make the experience much simpler for consumers to navigate,” Krause said.

There are so many negative outcomes to the way the billing system services patients now. 

Consumers don’t get the care they need, rises in collections actions, negative impact to finances and bad credit, Krause said. Not to mention ongoing sky-high administrative costs to providers and payers. What the problem boils down to is this: provider billing is uncertain because they have to process the claim before we can tell you what they owe, and it is driven by insurance benefits of that patient, which vary.  

Making matter worse, both providers and insurers are contributing to the problematic mass confusion. 

“We need to find a way to make it clear to a member as soon as possible after a visit exactly how much they owe,” Krause said. “We need benefit design that is smarter and easier to understand.” 

Krause will be speaking in the HIMSS18 session, “Create a Frictionless Healthcare Payments Experience,” at 4 p.m. March 7 in the Venetian, Palazzo B.

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Twitter: @BethJSanborn
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