09 Jan Transparency Trek: The Million EOB March
Trek (Trĕk) n.
- A journey or leg of a journey, especially when slow or difficult.
- A journey by ox wagon, especially a migration
I have been thinking alot about EOB’s. How did these anomolies of reason, this perversions of clarity, and obfuscators of objectivity come into existence? To what intent are they provided to the “beneficiary”. Every single person I have ever spoken to goes through the same five step process when they receive an EOB:
- “What the heck is this?”
- “That office visit or procedure costs what?!”
- “Wait, this isn’t a bill? Why are they sending me this?”
- “So, how much do I owe? Doesn’t my insurance cover this? I can’t figure this out. I’ll just wait till I get the letter from collections before I pay because it usually gets reduced and they’ll forget about it anyway”
- “Where is that shoebox where I stuff this stuff?”
Lets take a look at a real world EOB. It contains the price set by the provider (totally irrelevant), they also show the amount allowed (as a result of getting insurance club pricing), what the insurance pays (key data point), non-allowable fees that are removed (whatever that means), and then what the member (“beneficiary”) owes after all the c0-pays, co-insurance, and deductibles are accounted for. See below for an example:
So the providers “charged” $2,116.70, insurance says our “club price” is $1,799, and because you went to one of our in network or preferred providers, you save an additional $317.70. We, however, are only going to pay $1,259.30 and you will be responsible for the remaining $539.70 (This 70%/30% split is based on the type of plan; obviously lots of variations with this). This seems pretty straightforward, but not when you consider this is the third EOB you have received, in addition to 6 or 7 other bills from other providers who sent you a “courtesy” bill demanding full payment totallying the original $2,116.70 or additional statements form the lab, the anesthesiologist, and a wide range of people who helped on the service.
This gets repeated all over our country in every state, in every city, and nearly every home everyday. It is an unbelievably complicated mess.
Before stuffing it away, however, I would like to suggest something. Why not take 5 minutes and do something useful with it? Instead of stuffing it in the shoebox, recycle it. Or in other words, give it another shot at being useful, set it free, and post it online.
Here’s why. Those EOB’s, despite their current confused existence, are actually little gems that contain some very valuable nuggets of information. Like, the actual prices that insurance companies have negotiated with the various providers. Like, the entire propriety pricing scheme that keeps the various payers in a proverbial zero sum contest over how much value they can extract by squeezing providers while increases your rates every year. Interesting that payers have been so resistent to transparency in terms of revealing their pricing yet glibly publish it to all their members in the form of the EOB. Security (of their proprietary pricing schemes) through obscurity (widely disseminating proprietary information) is not a sustainable security scheme.
If the core competencies of the current insurance payers has been reduced to their abilty to manage Provider Networks and Administer Claims, and their profits are dependent on their ability to negotiate favorable pricing based on promised volume, then sharing “proprietary” pricing is obviously problematic. But, they are already sharing it. And the inevitable march of technology makes it possible for consumers to work together to share this information too.
So with all the talk regarding transparency, and the various pilots going on to improve transparency, why don’t we as patients band together to make this happen? Why not take these little EOB lumps of coal, distributed among thousands of us in a geographic are, and dig for the diamonds they contain?
So here is my proposition:
Lets have a nationwide Transparency Trek – lets call it the The Million EOB March. Can we get several hundred thousand consumers, to take 5 minutes to enter 7-10 key data elements readily available from their generic EOB’s*, and attempt to aggregate 1 million EOBs. Instead of all these multi-million dollar “transparency pilots” – why doesn’t someone pony up $1M to pay $1 for every legitimate EOB collected. Leverage the power of social network, real time collaboration, and the collective intelligence harness the information that is already being shared with us via our EOB’s?
The momentum from the first several thousand could inspire some self-insured companies** to contribute to the project; analytic teams could start to expose pricing by facility, provider, and region; others could aggregate the claims by episodes of care to get to “all in pricing” specific procedures which would allow true comparisons of outcomes to occur. Could be interesting!
Ready for a walkabout?
* Generic EOB’s only contain a fraction of the information available in the standardized electronic claims feeds that insurance companies refuse to share with individual policy holders.
** Self insured companies have access to much more detailed claims information as they are the insurance company and the traditional payers provide “Administrative Services Only”