In our super-hyped, 24/7, “reality”-crazed world, most everything is scaled-up to make it appealing, interesting, etc. This is true of media, products, and processes. How else can something compete for our attention in the cacophony that so characterizes today’s culture and business environment? Under these circumstances, we are increasingly losing the inclination and sadly – the support needed to focus on the types of “little things” that often make a big difference in our lives.
I have health insurance for my family through Kaiser and am blessed to have one of the most comprehensive coverage plans they offer. As such, we’re responsible for copayments of only $5-$10 for each office visit or occasion of service (lab tests or other diagnostic procedures). Kaiser policy requires patients to satisfy their copayment requirement at the point of service. This is critical because if the system functions properly, it minimizes the need for the people-intensive and costly process of billing and collection. Consider that we’re probably talking about thousands or even hundreds of thousands of patient encounters every day – with most of them requiring a copayment from the patient. This is a great example of a little thing that makes a big difference.
Unfortunately, I’ve found that there’s some dysfunction in the “little thing” I’m describing. Over the past 18 months, Kaiser’s patient registration system has repeatedly failed to determine the correct copayment amounts for services rendered to our family. As a result, I’ve received several statements from them requesting payment of $5 or $10 due to errors made in determining the copayment amount at the time of service. I’ve worked in healthcare finance my entire professional career and have seen thousands of patient bills/statements in a variety of formats. Based on my experience, I can say that Kaiser’s statements are some of the most confusing I’ve ever seen. Each of the statements I received listed all occasions of service within a given time period (generally 3-6 months) with the copayment amount due for each one, individual amounts collected (but not referenced by date of service), reversals of copayment assessments that were in error, and the corresponding revised copayment amounts. Did you get all that? It may be even more confusing when you actually see it. The statements were arranged in chronological order, not by date of service, but based on the date each transaction was processed. Because my entire family of four has coverage through Kaiser, all of the statements I received were at least 2-3 pages long (front and back to “save paper”). Initially, not wanting to take the time to “tick and tie” (an accounting term) all of the transactions, I just sent in the amount due at the bottom of the statement. When I received subsequent statements that included some or all of the transactions listed on the previous one (now including the last payment I sent by mail), I decided that I needed to “tie everything out”.
Again based on experience, I knew that this problem was “systemic”, most likely impacting thousands of Kaiser beneficiaries. I also knew that it was costing Kaiser a lot of money to bill me and others for erroneous copayments, to process the corresponding payments, and to offer telephone support to people who had questions about their bills. While it may not cost Kaiser $5 per claim for this process, it’s hard to imagine them getting a justifiable rate of return on the additional costs incurred.
The final straw came this week when I received a call from USCB, a self-described “Receivable and Resource Management Company”. See how deeply embedded the cultural zeitgeist is – when we feel compelled to apply a “happy-face” description to what is essentially a collection agency? Anyway, the agent was very pleasant but refused to tell me much of anything about the purpose of the call unless I was willing to provide certain personal information for purposes of “identification”. I understand about the requirements of HIPAA and concerns for personal privacy, but I also know that the verification process can be as extensive as they want to make it – obtaining as much information from me as possible while holding out the “carrot” of telling me what the call is actually about. We quickly reached a standoff, with the agent only willing to tell me that an account in my name had been referred by Kaiser. The call ended with me requesting and receiving a telephone number for the Kaiser department that had referred the claim.
The Kaiser representative was very helpful but as confused as I had been about the layout of the statement she called up on her computer. After about 10 minutes on the phone, she determined that a copayment in the amount of $5 (yes, FIVE dollars) had not been paid, so the account had been referred to collections. The date of service was back in July 2008. Despite my best efforts to “tick and tie” all the statements I had received, I apparently missed one amount – or did I? It turns out that the last statement showing this amount was issued in October 2008 and at the beginning of 2009, Kaiser converted to a new system. It appears that outstanding amounts from the old system were simply converted into a single “Balance Forward” item in the new system. Because we haven’t experienced any copayment errors since January, we didn’t receive any statements showing the unpaid Balance Forward. No statement – no payment, if no payment – the account is automatically sent to collections after a designated period of time. The Kaiser rep immediately agreed to write-off the account (despite my offer to pay over the phone) and proceeded to go back into the old system to make sure that there were no other amounts outstanding under any of our four Kaiser member numbers.
This entire process has caused me to ponder the number of “little things” (processes) in our financial systems that tend to be overlooked or forgotten. How many of these have become dysfunctional, costing institutions and companies millions of dollars that might otherwise be put to good use? Perhaps a reordering of priorities is called for…
