Toldeo Health Insurance

Eight Ohio insurance companies plan to simplify billing for doctors, consumers

For any patient who has ever spent hours on the phone with a hospital or doctor's office arguing about insurance coverage help is on the way.

Eight of Ohio's major health insurance companies, which provide coverage to 91 percent of the state's residents, announced Monday that they have created a Web site that gives doctors one place to find patients' benefit information. The program, they say, will reduce paperwork between physician's offices and health plans and, eventually, cut down on billing errors.

"This is analogous to the ATM technology that banks took on," said Karen Ignagni, president and chief executive officer of America's Health Insurance Plans, stressing the new technology's ease of use. "It's a step that will ultimately transform our health system."

While doctors will benefit from reduced billing hassles thus saving time, patients will benefit by seeing an increase in the amount of time their physician can spend with them, and a decrease in their own billing headaches, according to Ignagni.

The Web site will enable doctors offices to type in a patient's health plan and member identification number. They then will be able to review what treatments and procedures are covered by insurance, as well as check claim status and, in some cases, file claims.

America's Health Insurance Plan intends to launch the coordinated site next month in Ohio and New Jersey, but hopes eventually to rollout nationwide. In Ohio, the site will be available to nearly 30,000 doctors first, before being offered to hospitals.

Mark Jarvis, senior director of practice economics at the Ohio State Medical Association, said the new system will provide "transparency and clarity and the physician and practice staff will have more time with patients."

That's because individual physicians spend an average of 3.5 hours a week calling insurance companies and checking various Web sites to track billing claims and coverage. Doctors' staffs spend 58 hours a week, on average, working with insurers, Jarvis said.

In addition, consumers will be able to check with their doctors about cost prior to a procedure and therefore shouldn't be surprised by a bill. The Web site also should cut down on the number of times an insurance company rejects a patient's coverage due to "double-billing," which happens when a doctor's office re-files a claim because payment has not arrived, Jarvis said.

Streamlining paperwork and enabling doctors to spend more time caring for patients and less time dealing with bills has been a main talking point of the national health overhaul debate. President Barack Obama spoke with a group of doctors in the Rose Garden Monday, talking about administrative simplification.

The American Medical Association began fighting insurance companies' onerous medical coding and billing systems several years ago, putting out a report card saying that "billions of dollars in administrative waste would be eliminated each year" if insurers would send timely, accurate and specific responses to individual claims.

Dr. J. James Rohack, president of the American Medical Association, said insurance companies confuse patients and physicians on purpose.

"Because at the end of the day, an insurance company's profits are based on the medical care they don't pay for," he said.

Ohio's network of insurers said they, too, saw streamlined billing as a way to reduce costs and during an afternoon press call, one company called their participation "our efforts to reform the health care system in America."

Kelly McGivern, president and chief executive of the Ohio Association of Health Plans, said the state's insurers lobbied to be a pilot state. Ohio's insurers process over 38 million billing claims annually, she said.

"The goal is to provide more transparency up front so that physicians offices can help consumers with common questions."

Paul Apostle, vice president of enterprise development at Medical Mutual of Ohio, which has 1.6 million members statewide, said the system will likely spark a shift in the way doctors and patients talk about treatment. They will begin to talk about costs.

"You're going to see a lot more conversations in doctors offices," Apostle said. "This is where health care is headed."