Do you know how to read the Explanation of Benefits (EOB) you receive from your insurance company? If you answered yes, consider yourself lucky.

Communications from insurers to their members is a quandary that has been discussed for years. The issues include member confusion and frustration, potential financial obligations, denials, partial payments and, well the list goes on.

I thought a fitting way to open the first installment of the "Marketplace" was to share my New Year's resolution relating to healthcare: help as many people as possible in understanding their insurance benefits, how their claims are paid, how to read the correspondence they receive from insurance companies, and what methods are available for resolving issues. Each year, on average 45% of American adults make one or more New Year's resolutions and only 46% of them maintain those after six months, so I am trying to beat the odds here.

Providers and insurers receive calls on a regular basis from patients confused about what is covered and/or their financial obligations. The overwhelming lack of education among all people who carry insurance really hits home when it affects you personally. Similar to many people in their age group, my parents have multiple medical conditions which they manage. Associated with those conditions are regular monthly, if not weekly, medical bills, prescription renewals, diagnostic testing, etc. The average person (and education really does not play a role here) rarely understands how insurance billing works. Reason being, they are not brought into the process until there is an issue between the insurer and provider or a patient balance remains.

In my opinion the insurance companies and employer human resource departments can do a better job of educating their members/employees regarding benefit plans. In today's economy, we are all strained for resources. Improving the upfront education could resolve the administrative burdens that arise from the lack of understanding. While providing the information on a website is helpful, many in older generations struggle to access this information and may not have someone to help them. There are advocates that can assist them, however there are not enough to service the growing population in this demographic. As an example, my sister and I now serve as my parent's claims clearinghouse; billing, follow-up, reconciliations. We do it all !

We are "lucky" enough to work in an industry that is ever changing and causes confusion as a standard practice. But there is a bright side, as integral parts of the industry we have a better understanding of the avenues available for information and resolution. I encourage you to assist those who cannot interpret their medical statements or benefit plans: you have the knowledge that could change their lives. Do not make the assumption that someone may have the knowledge (including those within your own family) or is comfortable in asking for help. The last thing they need is a collection notice in their mailbox.

As you can tell, I'm rather passionate about Benefits...Future topics include Medicare Advantage, regulatory changes, strategies for success and more...

Opinions expressed in articles or features are those of the author(s) and do not necessarily reflect the view of the New Jersey Chapter of the HealthCare Financial Management Association, or the Publications Committee. The HealthCare Financial Management Association and the Publications Committee assume no responsibility for the accuracy or content of any article or feature on the website.