Closing the loop
On benefits eligibility and automated payment flows
I don’t give up or take no for an answer easily, especially when it comes from the broken US healthcare system.
Last week I scheduled a follow up appointment for an ongoing condition with a provider who has overseen my care for over twenty years. That provider is no longer in network for us after Blue Cross dropped them from our coverage. I followed an antiquated multiple-step process to attempt obtaining an approval from the insurer to cover the visit as a continuity of care appointment. My doctor advised me to call the insurance company to request a form which I had to send to the doctor’s office to fill out and fax back to the insurance. The office recommended calling Blue Cross to follow up because the approval would be needed in advance of the appointment and insurers were typically neither fast nor eager to approve these requests.
In my case, they did not. I had to pay hundreds of dollars out of pocket and will need to send a battery of forms to seek an out of network reimbursement. How is this possibly the way it still works? I spoke to several humans during the process and I don’t think I ever saw so clearly the disconnect between AI advancements and yet the lack of obvious application and adoption for it. Shouldn’t these flows all be seamlessly completed based on what I am eligible for? If you are working on solutions to make it easier for consumers to access and receive the benefits they are owed, please email me here and/or fill out this form. I look forward to hearing from you!