* Ways the healthcare industry could be easier to negotiate
When my mother passed away earlier this year, I knew my family was in for some big adjustments. After all, she was the one who kept all of the finances in order.
The medical bills from my mother’s five-month stay in the hospital were close to indecipherable. It was difficult to tell what was a bill, what was a statement and what was insignificant. My sister and I each spent a week at home getting everything in order, but needless to say a few months later, things began to pile up again.
It was at this time, that I began to wish for a way, online, to manage every piece of paper that came into the house without being there. Utopia, you might say.
The goal would be to set up a checks and balances system to make sure that what had to be paid got paid and that we could keep a record of everything coming in and going out of the house.
Now you might say online banking does most of this for you, but anyone who’s ever dealt with a long-term hospital stay and has suffered under the piles of paperwork knows that the actual bill-paying is the least of your problems. Knowing what to pay and what it’s for is the challenge.
See, there are several types of paperwork in the medical community. A statement of services. Bills from the physicians. Bills from the pharmacy. Bills from the hospital – hospitals in my mother’s case. Statements from Medicare. Statements from the insurance company. Knowing what is what off the bat would qualify you for Mensa status.
So that’s why the healthcare industry needs an easy-to-use comprehensive online tracking system for its customers and their families. I understand that the regulations of the Health Insurance Portability and Accountability Act (HIPAA) would make the system I’m dreaming of difficult. And let’s face it, the fact that under my system, every part of the healthcare industry would have to cooperate and become completely interoperable would make it impossible. But remember, I said this is Utopia.
With this system, as soon as a person is hospitalized, he or she could designate someone as a “guardian.” This person would be recognized as someone who could access his/her medical records and keep tabs on bills and bill payments.
The system would show all procedures being done by the hospital – sort of a real-time version of the traditional patient charts. With more and more hospitals getting computerized chart services, this would not be too difficult. So part one would be to have a chronological view of all medical information – doctors that have visited, medicine dispensed and other vital information.
The reason why this is critical is because as bills and statements start to come in from various doctors and the hospital pharmacy and the like, it’s near impossible to figure out what happened when and if there are duplicate statements. With my system, you could instantly match up what medicine was given for what procedure by what doctor. Anyone who’s tried to do this without such a system can testify that it is a daunting task.
Once you’ve matched the initial bills to the medical records, the next step is to track the status of the bills. With my system, there would be a mode for tracking where the bill is at that time. If you see that it needs to be sent to Medicare, you can do so online – let’s be completely Utopic and say this would happen automatically. If you have questions about the bill, you could call up a chat box with a Medicare representative to have your questions answered.
Once those questions were answered, you’d then have the option to ship the bill off the insurance company and flag it with the answers somewhere on the document. Again, anyone who’s been through this knows that you have to have seven conversations about one bill with both the insurance company and Medicare to get anywhere. It’s a frustrating, hair-pulling experience. Being able to make notes on the electronic bill would simplify things. And you’d have a record of who you spoke to and what they said.
Another feature I’d put on this system is an alert that would let you know when any party is demanding their money and threatening to take you to claims. This happens often in the world of medical bills. Sadly, you almost become numb to the threats. The original party – perhaps the surgeon – gets antsy that he hasn’t gotten paid, even though he knows it takes forever for the bill to wind its way through the system and sends out nasty notes. My online system would be able to automatically determine the validity of these notes and only alert me when I had to pay right then and there – which I would do automatically through my integrated online banking system.
Finally, my system would send me regular updates on everything so that I could see at a glance how everything was faring. There is nothing more nerve-wracking about dealing with medical bills than not knowing the status of all the various statements – did a bill come in yet for certain procedures? What’s happening with the insurance? Did the doctor double-bill (and don’t think this doesn’t happen because it does)? Is everything paid that needs to be paid?
Imagine the headaches a system like this could alleviate. There it is: My Utopia. Until then, I’ll be planning another trip to see my dad to ferret through all the paperwork. If you have similar stories, let me know at sgittlen@nww.com
