Comments on: This Is Not A Bill…

By: TD

TD — Tue, 24 Jul 2007 17:18:39 +0000

Thank you AnnMarie.
To what degree are Best Buy options chosen through evidence-based analysis - i.e. EB shows simvastatin is a Best Buy because it’s equally efficacious to branded alternatives, but cheaper? Do you do this?
Said differently: Is evidence a routine input into determining co-pays, etc.? Or only in those areas that happen to be covered by the DERPs, AHRQs, and NICEs of the world?
(Just curious how it works in the US.)

By: Paul Levy

Paul Levy — Fri, 20 Jul 2007 11:56:43 +0000

Barry has it exactly right. His approach is compliant with HIPAA. It would also save money because you could avoid paper mailings.

By: Peter S

Peter S — Wed, 18 Jul 2007 10:47:05 +0000

Barry’s suggestion on monthly EoBs is a good one. But it still won’t address the big difference between paying my credit card bills and the HRA/EOB review you describle: I know at the time of purchase how much the stuff I am buying with my credit card is going to cost. For most hospital or physician services, the EOB is the first time I get to see what the price/cost/negotiated rate is for the services I got. What’s being done at HPHC to help me get real time price information when that would be helpful to me in making a “purchase”?

By: AnnMarie

AnnMarie — Wed, 18 Jul 2007 10:22:19 +0000

I agree with Barry Carol that once a month would be sufficient for an EOB. Also the HRA check (and I am a Harvard Pilgrim Member and employee, like you Charlie) has no indication on it what the check is for, which for me is fine because we only have myself and my husband on the plan, and I hardly go to the doctor except for routine exams. But many people who have multiple family members going to the doctors on similar dates of services, have no idea what the check is “supposed” to go to and have a hard time matching it to an EOB.

I realize these come from different sources, but even pairing an EOB with an HRA check would be helpful.

Also - Barry Carol - the HRA check is generated by claims processing, not by any filing that the employee does, so there really is no hassle, it just shows up in the mail, which is nice, if you know what it’s for. You may be confusing it with an FSA - a flexible spending account - where the EMPLOYEE contributes pretax dollars and then submits for reimbursement. The HRA money is funded by the employer.

TD - there’s a nice chart on Harvard Pilgrim’s website called 5 facts about the Best Buy HMO. It’s a pdf file and page 2 is a pie chart that gives a high level overview of coverage. Basically select preventive services are covered in full to encourage preventive care- , hospital, diagnostic tests, labs and treatments are subject to the deductible.

By: TD

TD — Wed, 18 Jul 2007 08:39:19 +0000

How do you - the insurer - determine what’s in and what’s out of a Best Buy program?

By: Barry Carol

Barry Carol — Tue, 17 Jul 2007 14:54:45 +0000

The current EOB system has enormous room for improvement, in my opinion. My suggestion is to move toward sending a statement once a month rather than after each encounter with a provider. It should look more like a bank checking account statement and include the following information: date of transaction, name of provider, description of the service provided, CPT-4 or ICD-9 procedure code, list price, insurance allowance, member responsibility amount. There could be a total at the bottom for each financial field as well as cumulative year-to-date totals. For those who incur no healthcare costs, perhaps you could limit the statement frequency to once per quarter or just send an e-mail message in months where there were no transactions informing the member of that fact.

All of this information should also be accessible to the member on a secure website so he or she can review recent transactions at any time. My health insurer, Highmark Blue Cross, also still sends out the traditional EOB’s but has a pretty good website where transaction summaries can be reviewed. I can also view and print individual EOB’s if I need to. I have a Health Reimbursement Account (HRA) to cover my deductibles and co-pays with pretax dollars. I can print the appropriate summary information from the Highmark website and send it to the HRA plan administrator in one batch, which is my preference, toward the end of the year or when I’ve used up all the money in the account rather than go through the hassle of filing for a reimbursement each time I write a check for a copay or deductible.