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UMass Part Deux - MegaZone's Safety Valve
The Ramblings of a Damaged Mind
zonereyrie
zonereyrie
UMass Part Deux
Oh, since I was up WAY TOO EARLY this morning I left early and stopped by the docs on the way into work. I had two things to deal with - moving my appointment and figuring out why I was invoiced $115 for a visit that my insurance should've covered but didn't because they said I didn't have a referral form. Turns out I did have one on record, but the date got changed and the form didn't and Blue Cross is apparently too narrow minded to recognize that a referral for the same person within a couple of weeks of the date on the referral is for the same thing. So they're sending over a new copy with the actual date, which should take care of it. Total time spent - 10 minutes.

I should probably just never try calling and always stop by in person.

I am: neutral
Current Media: office buzz

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Comments
From: iwascaite Date: December 31st, 2003 12:27 pm (UTC) (Direct Link)
Could you imagine what the database matching would be like to automatically handle the kind of referral paperwork you mentioned? Gack. I am sure you already get enough problems just by only having one name....

And exactly what reasons would the insurance company have for making it easy for you? They make it difficult and you just pay the bill instead of spending 5 hours working on it, instant savings. Plus the longer it takes, the longer they can take to pay, and sure the twelvth of a percent is not a lot on your $115 bill, but summed over the millions they shell out on a monthly basis? There is no downside for them, there isn't a lot of economic pressure from customers because all insurance companies do this.

Honestly, what you want to happen is about a hundred times harder to handle than you think it is. It's trivial if you're talking about a person looking at it. Software to handle that kind of moving target is lightyears beyond what currently exists.
zonereyrie From: zonereyrie Date: December 31st, 2003 03:02 pm (UTC) (Direct Link)
It should be a faily simple fuzzy match. Doctor Match? Facility Match? Date within range? I've coded things like that in the past.
From: iwascaite Date: December 31st, 2003 04:05 pm (UTC) (Direct Link)
Maybe you have an insurance company that chucked all their old computers and old software and actually trained everyone. Chances are though, they have a system that includes legacy systems still running VMS, proprietary databases, and users from hell. You want to see software that makes banking look modern and streamlined? Health care billing.

[big HMO]'s software department hired a guy with one name about 6 years ago. Before then, it never occurred to them to test for that working in their databases. Consequently single-named patients were stored as first-name-only in one database and surname-only in the other and most of them (and anyone in their family) had two records therefore. Any sort of "fuzzy logic" implemented by these people is going to result in really odd problems.
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