Claims Problems

A recent review of the claims processing in healthcare found the system is extremely flawed. This is no surprise to anyone who has actually utilized the system. It is stated that the error-prone claims processing system eats up nearly one out of every three dollars that patients spend on healthcare in this country.

This data was taken from a survey of 200 hospitals and insurance executives and 1,000 consumers and the number would be even higher if they would have included a random survey of physician offices and billing services.

The hospital executives questioned in the survey stated that even without including physician offices, an average of one in five claims is delayed or denied, and 96 percent must be submitted more than once.

Patients who were interviewed also had many problems and 25 percent of consumers say their health plan denied coverage of a legitimate claim. Another one in five ultimately paid the bill out of their own pocket.

Many physicians feel that the insurance companies deny claims regularly and systematically in order to keep money longer or avoid paying altogether. Insurance companies know that many claims will be forgotten or employees and patients will just give up because of the frustrations.

There are ample stories from Floyd of claims related problems, patients sent to collections without ever being billed, denied claims, and the list goes on.

Illustration by John Ceballos