Health Insurers Have Good Reason to Push Data Integration

My wife went to the doctor's office a while ago and got a blood test, and the other day she got an invoice in the mail. No big deal, right? Probably just confirming what we thought: that her insurance, the information for which we definitely gave the doctor, covered the test.

Well, imagine our surprise when the final line on the invoice featured the full cost of the test.

There's something about a thousand-dollar bill that is transfixing. We just stared at it for a while, reading the list of charges we didn't understand and trying to see just how we could owe that much. It's funny, considering how much we eyed the paper, that it took us a while to see the small-type notation at the top. It said something like:

"We understand that you are a customer of [carrier], but require additional information about your employer."

That's interesting, because I assumed all that information was given to the doctor and input into their system. After all, it's on the card, and on the several forms filled out when you arrive.

It's not our insurance carrier's fault that two providers didn't transmit the information to each other correctly, or promptly, or whatever reason it didn't make it to the laboratory. But it was about to be, because I was ready to flip out for what I assumed was an untoward denial of coverage.

This must be why, when I talk to health insurers about electronic medical records, they invariably mention that the biggest barrier toward implementing them is getting providers on board.

For everyone's sanity — the provider, the payer, and the consumer, not to mention the employer who selects the coverage — the infrastructure for electronic medical records and insurance information must be built. The healthcare debate in this country is fraught with enough bad blood without easily avoidable mistakes being built in.

Nathan Golia is senior editor of Insurance & Technology. He joined the publication in 2010 as associate editor and covers all aspects of the nexus between insurance and information technology, including mobility, distribution, core systems, customer interaction, and risk ... View Full Bio