“I just wait for the letter from the collection agency — then I know I should pay.”

David Krause, Vice President of the Business Improvement Group at Anthem, knows the medical billing system in America is broken because he’s heard variations of the following too many times:

“I just wait for the letter from the collection agency — then I know I should pay.”

Consumers don’t get the care they need, rises in collections actions, negative impact to finances and bad credit, Krause said. Not to mention ongoing sky-high administrative costs to providers and payers. What the problem boils down to is this: provider billing is uncertain because they have to process the claim before we can tell you what they owe, and it is driven by insurance benefits of that patient, which vary.

Making matter worse, both providers and insurers are contributing to the problematic mass confusion.

“We need to find a way to make it clear to a member as soon as possible after a visit exactly how much they owe,” Krause said. “We need benefit design that is smarter and easier to understand.”

Unfortunately, between everything from massive inefficiencies to reliance on inefficient paper processing, providers and insurers are both contributing to the mess that is America’s healthcare billing system. We’re proud to say that OrboAccess not only drives value to our clients’ revenue cycle but goes a long, long way toward solidifying the reliability and customer-friendliness of “our side” of the billing process.

Anthem’s David Krause will be speaking in the HIMSS18 session, “Create a Frictionless Healthcare Payments Experience,” at 4 p.m. March 7 in the Venetian, Palazzo B.

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