Making steady progress
Houston, TX - “We have made steady progress with health insurance reform but more reform is still needed,” says Keith A. Bourgeois, MD, president of the Harris County Medical Society (HCMS), the largest county medical society in the nation.
Since the Harris County Medical Society’s Payer Survey in 2007 and the American Medical Association launched its annual National Health Insurer Report Card in 2008, there has been noticeable progress by health insurers in response to the organized medicine’s call to improve the accuracy, efficiency and transparency of their claims processing.
The American Medical Association’s (AMA) 2012 National Health Insurer Report Card showed a 17 percent improvement in response times by private health insurers to medical claims from 2008 to 2012. The fastest average response time was Humana at six days and the slowest was Aetna average response time of 14 days.
Progress also was made in private insurers paying claims correctly. The AMA Report Card showed the percentages of claims paid incorrectly by private health insurers have decreased from 19.3 percent in 2011 to 9.6 percent in 2012, resulting in $8 billion in health system savings due to a reduction in unnecessary paperwork.
“Although this is an improvement, it is still a large margin of error, resulting in health insurers paying nearly one in 10 medical claims incorrectly,” said Dr. Bourgeois. “We need health insurers to pay correctly the first time, which will save money and allow the physicians to spend more time on patient care and less on unnecessary administrative work.”
According to the AMA, an additional $7 billion could be saved if private insurers paid claims correctly. UnitedHealthcare had the best accuracy rating of the top seven large commercial health insurers with an accuracy rating of 98.3 percent. And, Anthem Blue Cross Blue Shield made the largest improvement, going from 61 percent accuracy rating in 2011 to 88.6 percent in 2012.
“It’s frustrating for us and our patients,” says Dr. Bourgeois. “With each insurer having a different policy for payments as well as each group policy within an insurance company being different, we often cannot tell our patients what their actual costs for the visits will be at the time of the visit.”
Organized medicine has been calling for more transparency and standardization to improve these processes so that medical claims can be submitted and settled at the patient’s point of care, allowing patients to know their out-of-pocket costs prior to treatment.
The Report Card also showed more improvement is needed with denials and pre- authorizations. The Report Card showed medical claim denials increased in 2012, reversing a downward trend that occurred between 2008 and 2011. Humana was the only insurer of the seven insurers that did not have an increase in denials. The Report Card showed Anthem Blue
Cross Blue Shield had the highest denial rate at 5.07 percent.
Also, medical services requiring prior authorization from health insurers increased by 23 percent since 2011, which amounts to 4.7 percent of all claims requiring prior authorization. The AMA estimates this will increase administrative costs by $728 million in 2012.
“The AMA estimates that physicians’ offices now spend an average of 20 hours per week on insurer preauthorization requirements, which reduces the time we spend with our patients and can cause a delay or interruption in patient care,” said Dr. Bourgeois.
“While we are very encouraged with the latest Report Card, we hope that by continuing to work with health insurers we can see more growth in insurance reform,” said Dr. Bourgeois. “This is not just important for physicians, this is important for proper patient care.”
HCMS, established in 1903, is the professional society for physicians in Harris County. It is the largest county medical society in the nation, with a membership of nearly 11,000 physicians and medical students. Its mission is to be the leading advocate for its member physicians, their patients and the community, in promoting the highest standards of ethical medical practice, access to quality medical care, medical education, research, and community health. In 1915, HCMS incorporated the Houston Academy of Medicine to support the community service, education, scientific and charitable programs for physicians, their patients, and the community at large in Harris County.
The National Health Insurer Report Card provides an annual check-up for the nation's largest health insurers and diagnoses the strengths and weaknesses of the systems they use to manage, process and pay medical claims.
Note: The findings from the 2012 National Health Insurer Report Card are based on a random sampling of approximately 1.1 million electronic claims for approximately 1.9 million medical services submitted in February and March of 2012 to Aetna, Anthem Blue Cross Blue Shield, Cigna, Health Care Service Corporation, Humana, Regence, UnitedHealthcare and Medicare. Claims were accumulated from more than 380 physician practices in 79 medical specialties providing care in 39 states.