I personally experienced the roll-out of Anthem BC-BS’s new patient billing initiative. As is well known, and as I’ve discussed in detail, patient billing, both from providers and payers, is a nightmare for everyone involved. Fixing it appears to be tough – it’s worse than being between a rock and a hard place; billing is between a rock, a hard place, the devil and the deep blue sea.
As I’ve said many times, Anthem is one of the best health insurance companies out there, full of hard-working, well-meaning people who just want to do the right thing. Their many efforts at making things better demonstrate this. But there’s clearly something about being a giant organization with lots of extensive, complex software that seems to make things go wrong. Small, entrepreneurial organizations can sometimes avoid the usual traps and turn out great, high-quality software quickly. But the big, lumbering bureaucracies just can’t seem to follow the clear patterns of success demonstrated by the winning the upstarts. Everything is against winning. They follow the regulations, the best advice of the best experts from industry and academia, and the results are consistent. Consistently bad.
Getting things badly wrong in software is most often a team effort. When it’s wrong, it’s rarely an ooops, how did that happen? I’ll fix it and then we’ll be OK! It’s more often pervasive, multi-dimensional badness. Anthem’s billing break-through is clearly the typical case.
In this post, I’ll describe the break-down, the fact that the new billing effort is broken. Again: this is not about Anthem specifically. It’s an example of a pervasive issue.
What led me to discover the new patient billing feature was an email I got from Anthem. That’s a story in itself, which I tell here.
While I was on the site, I had occasion to carefully examine the welcome page:
I noticed something new since last time I was there – the ability to pay provider bills. Wow! I’d never heard of any insurer offering this capability before. Of course I want to try out this amazing bill-paying break-through.
I’d better step back for a moment and explain the billing situation in healthcare, because when you just glance at what you’re about to see, you might think it’s no big deal.
In US healthcare insurance, there’s something called a “co-pay.” This innocent-sounding term is the cheerful face of a nightmare for all involved – patients, providers and insurers. At some point, I have no idea when, someone decided that insured patients should pay a part of their cost of their care, a bit like the well-known general insurance of a deductible, but fancier. The idea is that, for each service a patient gets, insurance would pay part of it, if the service is covered at all. Then, depending on a whole bunch of other things like whether a provider is “in-network,” the patient should pay something to the provider, an amount that the insurance company calculates using arcane formulas that are secret. Here is a detailed example.
So get this: you have insurance. You go to a covered provider to get a covered service. The insurance company pays some of the provider’s bill. The provider generates a bill for you, sometimes when you check out, but often much later, in the mail. The provider’s bill includes an amount you have to pay directly to the provider. That’s the co-pay.
This is the context that helps you understand Anthem’s billing break-through: instead of getting random bills in the mail from random providers and having to write checks and mail them various places, Anthem is letting you go to one central place and take care of them. Even electronically! A great convenience.
Health insurance companies are ideally positioned to provide this service! They already have the complex systems set up to transfer money to providers (doctors and hospitals) electronically, because they’re already paying them! Setting this kind of system up from scratch is hard, and maintaining it with all the changes to bank accounts, etc. takes a lot of work. Leveraging all that infrastructure to enable patients to pay their bills is a great idea.
Even better, the insurance company knows how much the patient is supposed to pay the provider! Even though the normal procedure is that the providers bills the patient, all the numbers ultimately come from the insurance company. So all the required data and systems are already in place! What a fabulous opportunity!
Naturally, I dove right in to trying it out. Here’s what I saw right away:
Now I’m getting really pumped – it’s exactly what’s needed!
I ask for the list and see a juicy target to pay:
Perfect, a typical co-pay. I click to see the details of the claim. Typical stuff, as expected:
Of course, it's a bill that no one but a clueless health insurance company would have the nerve to create. It doesn't tell me who provided the service, when the service was provided, where it was provided or what the service was. Other than that, it's great! Oh and by the way, they don't seem to know whether I actually owe this money or whether I've already paid it. In fact, I happen to know I have already paid it!
I know, complain, complain. But still, moving ahead...
I’ll spare you the details of how I had to provide payment information. I did it and authorized payment. Then I got this lovely screen:
Yes, that’s the whole screen. The technical term for this kind of screen is “face plant.” A “face slap” is when there’s an error, but the software knows it and can give you a nice error message with something soothing about how things aren’t as bad as they look. When you’re on a site labelled Anthem and then suddenly you’re no longer on their site and some other company’s logo appears, you know that the two bodies of software are in all-out war. You know the war has gone nuclear when the dreaded “500” error appears. That’s not an error message generated by software that is confused and knows it’s in trouble – that’s an internal website server error. This means things have gone so bonkers that the software that’s supposed to handle things has gone AWOL, and all the server can do is say, in technical terms, is OOPS.
So I re-grouped, went back to the start, picked another bill, put in my credit card information (again!), and authorized payment. Here’s what I got for my trouble:
Things are getting better – we’ve advanced from a full-on face plant to a relatively mild face slap error – no one else’s logo is in sight, no servers are complaining (at least visibly). It just plain doesn’t work.
Anthem presents bills that fail nearly all the criteria required of a reasonable bill. Their bill payment mechanism doesn't work. Even if the final step of paying the bill worked instead of face-planting or face-slapping, it would still be near-worthless! What good is a bill that doesn't actually show what you owe? Doesn't show when, where or by whom the service was provided, or even what the service was?
Here is the simple conclusion: Anthem claims to have a revolutionary method to enable patients to pay their providers, a great convenience. If it works. Which it doesn’t, to varying levels of embarrassment.
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