As Director of Compliance of a Health Plan, thank you for the comments from Mr. Blasi. We do not deliberately try to make any thing confusing - our goal is to make things as clear as possible, and it is often amazingly difficult to accomplish that, and the examples that Mr. Blasi provides show just the tip of the iceberg. We are all for standards that give both payers and providers adequate, accurate information at the first pass so we don't have to go back and forth. If any provider does not understand the EOB from a payer, please have dialogs about what can be done to make things more clear. Tomese Buthod Director, Compliance/Projects Passport Health Plan 502-585-7925 502-585-6060 (fax)
-----Original Message----- From: David Blasi [mailto:[EMAIL PROTECTED]] Sent: Friday, May 31, 2002 9:00 AM To: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED] Cc: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: RE: Hi All, and putting detailed info on EOBs The comments you make are exactly why we are dealing with HIPAA transactions and code sets. Standards so providers and payers all speak the same language. However, I believe I saw something in the past about using this site in a productive manner. I would take issue with come of the comments made in the last two messages. You are correct that everyone wins when EOB's are clear on both the provider and member side. Which is why I find it difficult to believe that payers deliberately make things confusing. System limitations, budget constraints, multiple plans with different claims determination rules, adjudicating claims fast and efficiently through auto-adjudication, COB and many other issues come into play in notifications that may not appear clear. I have seen Medicare, Medicaid EOB's and the only thing more clear about them is you see them all the time. There have been other efforts to make the system better. DOL claims regulations requirement of certain disclosures on EOB's are one example. If you have issues with certain EOB's talk to your higher volume payers and seek a productive dialogue about how things can be made more clear. Sometimes things are complicated and there just isn't a clear way to connect medical terminology to laymen's terms. Try to explain to a patient why there are three different charges for one test and how each one was paid. Sometime it is not an easy task. >>> "Daniel E. McDonald" <[EMAIL PROTECTED]> 05/31/02 12:46AM >>> Dawn: I have worked closely over the past two years with multiple payer organizations over the past two years and I can assure you that the payer believes that less is better. Having worked on both sides of this issues I feel the providers and patients suffer. Neither can communicate effectively with each other because the Provider Summary and the Patient's EOB have different verbiage and numbers on them. A provider and patient can barely discuss the financial settlement anymore because the payers do their best to make it unclear. I saw a program on TV last night discussing generic medications and how the big drug companies play the system to keep the generic drugs from market so they can make more profit for their shareholders. The payers are doing their best to do the same with confusing the reimbursement process. I for one would invite discussions on a national healthcare insurance system similar to Medicare that would be controlled by a single governmental entity. Medicare pays most of our physicians better than most of the managed care plans with less hassle! I am not one to ask for government involvement but there has to be a better way. Who has the nice big beautiful glass skyscrapers? The Insurance Companies. Ask yourself how they afford it. I no a large payer that built their own skyscraper to spend some of those dollars!!!! Sorry for the long winded response but the payers do not want this reconciliation to be an easy process. Daniel E. McDonald ProvidrServ, Inc. 4590 Lincoln Road Indianapolis, IN 46228 (317) 299- 6450 x 114 (317) 299- 6436 Fax -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] Sent: Thursday, May 30, 2002 04:06 PM To: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED] Cc: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: Re: Hi All, and putting detailed info on EOBs Speaking from the Provider standpoint, physician practices are not at all pleased with the lack of depth of information on EOBs. Major consultants are advising doctor's offices to request that patients share the EOBs that they receive so that the doctor's office can make heads or tails out of what the insurer is paying. When a physician has to resort to that level to find out what they are being paid for, that reflects pretty poorly on the insurer in both the patient's and the physician's eyes. It only makes good business sense to provide accurate, detailed information on payments on EOBS, no matter to whom they are mailed. The staff resource savings on answering questions alone would pay the additional cost, not to mention the increased ease of doing business. I'd be happy to talk to anyone on or off line about this issue....it is HUGE from a physician practice standpoint. Dawn Holcombe Executive Director Oncology Network of CT, LLC 435 Buckland Road - Rosewood Building South Windsor, CT 06074 860-644-7282 860-644-7475 fax 860-305-4510 cell [EMAIL PROTECTED] ********************************************************************** To be removed from this list, go to: http://snip.wedi.org/unsubscribe.cfm?list=privacy and enter your email address. ********************************************************************** To be removed from this list, go to: http://snip.wedi.org/unsubscribe.cfm?list=privacy and enter your email address. ********************************************************************** To be removed from this list, go to: http://snip.wedi.org/unsubscribe.cfm?list=privacy and enter your email address. CONFIDENTIALITY NOTICE: This electronic mail may contain information that is privileged, confidential, and/or otherwise protected from disclosure to anyone other than its intended recipient(s). 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