• Premera’s Online Tool Allows Doctors to Calculate Patients’ Benefits, Expenses Immediately

    Technology Brings More-informed Healthcare Decisions, Faster Claims Processing

    MOUNTLAKE TERRACE, WA. – (January 29, 2009) – At a time when people are closely watching their dollars, Premera Blue Cross has introduced an online tool enabling patients to make clearer financial decisions about their healthcare, and allowing doctors and other professional providers to be paid more quickly for their services.

    Premera’s new real-time cost-estimator and claims-adjudication tool will let providers produce nearly-instantaneous out-of-pocket expense estimates for patients. They’ll also have the option of using the Web-based program to submit their claims to Premera for processing in real time, cutting paperwork and postage and shortening the period for reimbursement by days.

    “What I like about it is that it gives us a much more accurate estimate of what the patient’s out-of-pocket money will be,” said Kris Linden, office manager of OB/GYN Associates in Spokane, a practice of six doctors and two nurse practitioners. “Before, we never knew where they were in their deductible, so we always gave them a larger range. It was looser.”

    Kirsten Johnson, billing specialist for the Eye Clinic of Edmonds, with one ophthalmologist and one optometrist, added, “We have had no glitches, no problems. I have seen payments within a week and there have been no issues as far as errors.”

    Providers historically have had to wait until after they receive insurance payment to finalize their patients’ bills. This often causes confusion for patients and long delays in settling accounts. Premera has found in focus groups and individual interviews that consumers want to know their personal financial responsibility for healthcare procedures at the time of service.

    Easing Doctors’ Burdens

    Lower-premium, high-deductible plans are increasing the burden of billing and collecting out-of-pocket expenses on healthcare providers. The Premera tool not only supports administrative efficiencies, but also gives providers a way of collecting payments at the time of service. Patients are served by better understanding their cost of care at the time of service.

    “Patients are much more comfortable with the amount to be collected because the figure is coming directly from the insurance company,” said Linden. “It’s as if the estimate has been blessed; it is more credible.”

    The real-time estimates-and-claims-adjudication tool grows out of Premera’s transparency goals and reflects its approach to understanding and meeting provider needs. The Mountlake Terrace-based health plan partners and collaborates with providers, inviting them to try new technology and making improvements based on their feedback.

    In early 2007, Premera was the first health plan in Washington to deliver an out-of-pocket estimator tool to hospitals. This tool helps hospitals and patients by providing an accurate estimate of the patient’s financial responsibility. The estimator’s success prompted Premera to deliver a similar version to contracted professional providers. Seven clinics in Washington began using the new online tool in early December 2008. Premera will be rolling out the cost estimator to physician practices throughout Washington, Oregon, Alaska and Arizona through the first half of 2009.

    How it Works

    The estimates-and-claims tool appears on Premera’s Web site in a secure area of the Provider Portal.

    The system works like this: A patient arrives at the doctor’s office for treatment. The physician or staff enters the patient information and service details, like procedure and diagnosis codes. The computer uses data such as the doctor’s fee schedule, the patient’s benefit plan, remaining deductible, copay, coinsurance and out-of-pocket maximum to generate an estimate. Estimates are calculated in real time to ensure accuracy, and the computer response is delivered in 4 to 7 seconds.

    Doctors and their office staff can print out the estimate for their patients showing how the patient share of cost was calculated. The estimate would include total charges, fee adjustments, costs not covered, what the member’s plan will pay, the deductible, copay and coinsurance. At the end of the list would be the balance to be collected from the patient – at that time, by credit card, for example, or through an arranged payment plan. Doctor and patient might also choose to discuss alternative treatments.

    The estimate of the patient’s responsibility will be accurate at the time it is made. However, it’s possible in some instances the final amount could be different – if the patient’s accumulated deductible changed between the time the estimate was generated and the actual claim was processed, for instance.

    The new technology promises wider transparency and more help for consumers in knowing what their costs will be, upfront.

    “As the economy gets tighter, it will be to the benefit of the patient and the doctor’s office to be able to have this discussion about what the out-of-pocket costs are going to be, rather than waiting until everything is processed. It eliminates the surprise factor,” said Linden.

    Just as significantly, doctors can spend less time collecting payment and concentrate on what they do best – the practice of medicine.

    About Premera Blue Cross

    Our mission is to provide peace of mind to our members about their healthcare coverage. We provide healthcare coverage and related services to more than 1.3 million people. Premera Blue Cross has operated in Washington since 1933, and Alaska since 1952. Premera Blue Cross is an independent licensee of the Blue Cross Blue Shield Association. Premera Blue Cross is a member of a family of companies based in Mountlake Terrace, Washington, that provide health, life, vision, dental, and long-term care insurance, and other related services. In the J. D. Power 2007 National Health Insurance Plan Satisfaction Study, Premera Blue Cross ranked highest in member satisfaction among health plans (regional and national companies) serving the western U.S. 2007 was the first time J. D. Power surveyed consumers about health plans.