MY HOLIDAY WISH: THE IDEAL EXPLANATION OF BENEFITS
by Ed Lanigan
Senior Strategist
From all the news and debate of the last few months, it’s clear that our current health care system is complex, burdened with conflicting interests, and emotionally charged, making it very difficult to reform. To date, reform legislation has passed the U.S. House of Representatives, and now the Senate is working on its version. We’ll see what kind of health care bill emerges in the coming months.
In the meantime, we thought we’d take advantage of some holiday season magic. If we could write to Santa and ask for just one small health care reform gift, what would it be? Putting aside requests for miraculous cures (or world peace for that matter), maybe we could ask for an ideal health care system in which everyone was covered (and funding was not an issue).
Not even Santa can deliver such tall orders, so we narrowed our thinking and came up with something more practical – the perfect Explanation of Benefits (EOB).
To help clarify what would be different, we compared our EOB wish list with the typical EOBs that most people receive after a doctor visit. In short, this special gift from Santa would convey a feeling of reassurance and inclusion – that everything will be okay.
Fortunately, we don’t need to call on Santa or his elves because an improved EOB is not just a figment of our imaginations.
Recognizing the need for improvement, a number of health insurance firms have recently begun to redesign their EOBs. To help move this trend forward, one agency – DALBAR – is developing a ratings standard that can be used to evaluate EOBs from health insurers across the country.
DALBAR’s first EOB ratings report will be published early in the New Year. To learn more about their work and the ratings criteria they have been developing, view our recent joint Webcast.
Maybe it will take a push from all sides – Congress, health care providers, carriers, insurance industry competition, the public, and you and me, to ensure that health care is reformed in a way that is reassuring, inclusive and communicated clearly to all.
If we believe, then maybe we can make it come true.
All of us at Addison wish you all a happy – and healthy – holiday season!
Senior Strategist
From all the news and debate of the last few months, it’s clear that our current health care system is complex, burdened with conflicting interests, and emotionally charged, making it very difficult to reform. To date, reform legislation has passed the U.S. House of Representatives, and now the Senate is working on its version. We’ll see what kind of health care bill emerges in the coming months.
In the meantime, we thought we’d take advantage of some holiday season magic. If we could write to Santa and ask for just one small health care reform gift, what would it be? Putting aside requests for miraculous cures (or world peace for that matter), maybe we could ask for an ideal health care system in which everyone was covered (and funding was not an issue).
Not even Santa can deliver such tall orders, so we narrowed our thinking and came up with something more practical – the perfect Explanation of Benefits (EOB).
To help clarify what would be different, we compared our EOB wish list with the typical EOBs that most people receive after a doctor visit. In short, this special gift from Santa would convey a feeling of reassurance and inclusion – that everything will be okay.
| Typical EOB Difficult to read and understand – "What do all these remarks codes mean?" Math does not add up – "Was my deductible applied or not?" Scary because you don't know how much you have to pay – "If 'This Is Not A Bill,' then what is it?" Conveys a feeling that the insurance company just "denies" all claims, and that you will be left out in the cold – "This was an Emergency Room visit, so why wasn't my claim paid?" | The perfect EOB from Santa's workshop Easy to read and understand Clear math that adds up A document that helps you plan your health care, reminds you of preventive care check-ups, and helps you navigate difficult decisions Conveys a feeling of reassurance and inclusion, that everything will be okay |
Fortunately, we don’t need to call on Santa or his elves because an improved EOB is not just a figment of our imaginations.
Recognizing the need for improvement, a number of health insurance firms have recently begun to redesign their EOBs. To help move this trend forward, one agency – DALBAR – is developing a ratings standard that can be used to evaluate EOBs from health insurers across the country.
DALBAR’s first EOB ratings report will be published early in the New Year. To learn more about their work and the ratings criteria they have been developing, view our recent joint Webcast.
Maybe it will take a push from all sides – Congress, health care providers, carriers, insurance industry competition, the public, and you and me, to ensure that health care is reformed in a way that is reassuring, inclusive and communicated clearly to all.
If we believe, then maybe we can make it come true.
All of us at Addison wish you all a happy – and healthy – holiday season!
