Posts Tagged ‘Healthcare insurance companies’

Everybody’s Warming to Telemedicine

Tuesday, May 15th, 2012

Tired of feeling sick but worried about the cost of a doctor’s visit? A rural Minnesota woman recently logged onto an Internet site run by NowClinic Online Care, a subsidiary of health insurer UnitedHealthcare, and “met” with a doctor in Texas.  According to Kaiser Health News, after talking with the physician via text message and by telephone, the woman was diagnosed with an upper-respiratory infection and prescribed an antibiotic.  .The doctor’s “visit” cost just $45.  “I was as suspicious as anyone about getting treated over the computer,” said the woman, who did not have healthcare insurance.  “But I could not have been happier with the service.”

NowClinic, which debuted in 2010 and currently operates in 22 states, is part of the upsurge of Web- and telephone-based medical services that experts believe is transforming the delivery of primary healthcare.  The movement gives consumers easier access to reasonably priced, round-the-clock care for routine problems — often without having to leave home or work.

Insurers such as UnitedHealthcare, Aetna and Cigna, and employers such as General Electric and Delta Air Lines are getting on board, advocating telemedicine as a way to make doctor “visits” cheaper and more easily available.  Proponents also see it as an answer to a deteriorating physician shortage.  Nevertheless some physician and consumer groups worry about the trend.  “Getting medical advice over a computer or telephone is appropriate only when patients already know their doctors,” said Glen Stream, president of the American Academy of Family Physicians.  “Even for a minor illness, I think people are going to be shortchanged.”

Carmen Balber, a spokeswoman for Santa Monica-based Consumer Watchdog, is concerned that lower co-payments will cause people to see doctors or nurses online just to save money.  “People will choose the more economical option, even if it is not the option they want,” she said.

Employers are getting mostly positive reviews.  “Our employees just love the convenience, the low cost and the efficiency,” said Lynn Zonakis, managing director of health strategy and resources at Delta Air Lines, which offers NowClinic for $10 a consultation.

The global telemedicine business is projected to almost triple to $27.3 billion in 2016, according to a report by BBC Research.  “Virtual care is a form of communication whose time has come and can be instrumental in fixing our current state of affairs within the healthcare system,” said Robert L. Smith, a family doctor in Canandaigua, NY, and co-founder of NowDox, a telemedicine consulting firm.  The field developed gradually over four decades as a way to deliver care to geographically isolated patients.  That’s changed over the past 10 years thanks to the development of high-speed communications networks and the push to cut health costs.  “It’s the wave of the future,” said Joe Kvedar, director of the Center for Connected Health, founded by Harvard Medical School.

Just one major hurdle remains: Many state medical boards make it complicated for doctors to practice telemedicine, particularly interstate care, by requiring a prior doctor-patient relationship, according to Gary Capistrant, senior director of public policy at the American Telemedicine Association.  “The situation seems to be getting worse, not better.”  He cited a 2010 ruling by the Texas Medical Board that effectively blocked a physician from treating new patients via telemedicine.  The sole exception is in cases where the patient has been referred by another physician who evaluated him or her in person.  “It’s about accountability,” said Dr. Humayun Chaudhry, CEO of the Federation of State Medical Boards.  State boards insist on licensing doctors treating patients in their states so that if patients are injured, they have a state agency they can go to for help.

“We want to enable telemedicine to flourish, but at the end of the day we want patients protected,” Chaudhry said.

OptumHealth, a UnitedHealth Group subsidiary that operates the NowClinic, said it leaves it to physicians to determine if they can diagnose a patient via computer.  “This is not intended to replace the intimacy of the doctor-patient relationship,” said Chris Stidman, senior vice president.  The company did not reveal the number of people have used the service or how many physicians it employs.

Healthcare Claims Errors Cost $17 Billion a Year

Monday, July 11th, 2011

A recent American Medical Association (AMA) survey has determined that claims-processing errors by healthcare insurance companies cost the nation $17 billion a year in pointless administrative costs.  The AMA’s study is based on a random sampling of approximately 2.4 million electronic claims submitted in February and March of this year to Aetna, Anthem Blue Cross Blue Shield, CIGNA, Health Care Service Corporation, Humana, the Regence Group, United Healthcare and Medicare.  The claims were filed for more than 400 physician groups in 80 medical specialties in 42 states.

The typical claims-processing error rate was 19.3 percent, a rise of two percent over 2010 and is expected to add $1.5 billion in administrative costs this year.  “A 20 percent error rate among health insurers represents an intolerable level of inefficiency that wastes an estimated $17 billion annually,” said AMA Board Member Barbara L. McAneny, M.D.  “Health insurers must put more effort into paying claims correctly the first time to save precious healthcare dollars and reduce unnecessary administrative tasks that take time and resources away from patient care.”  To promote a more efficient claims payment system, the AMA’s National Health Insurer Report Card provides a yearly check-up for the largest health insurers and benchmarks the systems they use to manage, process and pay claims.

America’s Health Insurance Plan’s (AHIP) spokesman Robert Zirkelbach said insurers and providers must share the responsibility for improving accurate and efficient claims payment.  “According to Zirkelbach, “Health plans are doing their part by collaborating with providers and investing in new technologies to improve the process for submitting claims electronically and receiving payments quickly.  At the same time, more work needs to be done to reduce the number of claims submitted to health plans that are duplicative, inaccurate or delayed.”

Medicare came out ahead of the commercial insurers, with a 96 percent accuracy rate.  The lowest rated firm was Anthem Blue Cross, at 61 percent.  Anthem’s parent company, WellPoint Inc., is expanding electronic claims processing operation to improve accuracy.

The National Health Insurer Report Card is the basis of the AMA’s Heal the Claims Process campaign. Launched in June 2008, the campaign’s goal is to encourage improvements in the industry’s billing process so physicians and patients are no longer at the mercy of a chaotic payment system.  “In spite of notable improvements by insurers in the four years since the AMA introduced the National Health Insurer Report Card, precious healthcare resources are wasted because each insurer uses different rules for processing and paying medical claims, Dr. McAneny said.  “This variability adds no value to the healthcare system and only increases unnecessary administrative costs.”

To help physicians enhance their management of each insurer’s claims-submission requirements, the AMA’s Practice Management Center offers user-friendly online resources for preparing claims, following their progress and appealing them when necessary.  The Practice Management Center’s educational materials and practical tools are available online at

Another of the report’s findings is that physicians were not reimbursed by healthcare insurance companies on almost 23 percent of submitted claims.  The reason usually provided for non-payment are deductible requirements that shift payment responsibility to the patient until a dollar limit is met.

According to AHIP president Karen Ignani,“Administrative simplification that benefits consumers and the physicians who serve them is a top priority for our community.  Recent data from PricewaterhouseCoopers indicate administrative costs have been stable for four decades.  As a result of the move to electronic processing, the cost for each claim has actually declined, enabling insurers to provide value added services to consumers, such as disease management programs, without contributing to rising healthcare costs.  AHIP data indicate that virtually all ‘clean’ claims are processed within 30 days.

“AHIP members have worked collaboratively with physicians to make improvements in processes to promote efficiency and move to real-time payment.  In order for claims to be processed as efficiency and promptly as possible, both insurers and physicians need to strive for accuracy and timeliness.  For example, data show there is often a significant lag time between when services are provided and physician claims are submitted.  Data also indicate that there are a significant number of incomplete and duplicate claims filed.  Reports released last week decried ‘no questions asked’ reimbursement in Medicare and emphasized the need to scrutinize claims to prevent fraud.  In addition, research shows more than $200 billion is spent annually on services that are not in sync with the rigors of medical science, the result of wide variations in practice, overuse, underuse, and misuse of services.  Our view is that discussions of efficiency are important, but that they should be broad discussions of opportunities for improvement by all the responsible stakeholders.”