Lisa, Lisa, Lisa ---

Hope you meant that rhetorically (LOL)! No, it's not just because you're working on this project! It's just the "system" in the US today's. As I say to my family & friends, "when I get to be Queen..." We all spend way too much time & energy on paperwork, etc. This includes medical personnel. Without going on my soapbox, no one really wants to hear it I'm sure, it's absurd to have more admin than medical staff today's avg doctor's office & probably >50% in hospitals today. I'd much rather spend more time with my husband & kids and not work 60+ hrs/wk plus keeping up w/the paperwork & household bills.

I have friends who pay others to manage this all for them. Too expensive for us.

Barrie

I wonder... Do you think people are becoming more

aware of these problems than they used to be?

Yes. Sort of. They're more aware because the problem's getting worse.

And if so, why? Sometimes I think I just notice these

stories more nowadays because I am working on a

related product.

I agree with Barrie on this: No.

The paperwork burden is becoming more onerous. The healthcare consumer is having to deal with that paperwork for even the most simple procedures today. As to "why" this is occurring, I believe that the article hits the high points, except that it overlooks the effects of HIPPA and they way in which providers and insurance companies misinterpret the legislation.

I also have a personal theory about how profit margins which used to go to the provider are being distributed among the other players thereby reducing providers ability to spend on automation systems at the source of the paperwork trail. However, I'll try to stay off my soapbox as well... or am I too late. ;-)

-Tony

I wonder... Do you think people are becoming more

aware of these problems than they used to be? And if

so, why?

1. Baby boomers are getting older and having more medical expenses. Get something like cancer and it (paperwork) mushrooms out of control quickly.

2. Baby boomers' parents are even older than they are and facing even more medical expenses. More prescriptions, more medical supplies, more surgical solutions, etc. They may live longer, but there is a cost. My mother has two wheelchairs and my dad just had to get a script for an accessory for the wheelchair. Then the part was back-ordered, then it didn't work right so he had to go to the hardware store and create a solution...

3. More medical expenses, more chance for errors.

4. Simple indemnity plan turned into choices between indemnity plan or HMO which has now turned into multiple types of plans with varying levels of deductions and FSA or HSA or new pre-tax dollar medical savings plans.

5. New services that didn't used to be considered "normal". Yesterday I was at an OB/GYN open house for his new Medical Spa and Laser Center. They had just opened a "spa" for skin care, hair removal, spider vein zapping, etc. Their reason--insurance companies are just not paying what they used to and they weren't making enough money. No OB/GYN ever cared about anything but my parts and suddenly he wants to convince me my skin needs beautifying...

6. There are more hands in the pot...many people I know have 2 or 3 insurance companies. Just more confusion.

7. Medical costs are escalating. If medical expenses are noise in the budget, you do it and move on. But, for me, it is over $100 to go to the dentist and have my teeth cleaned and checked. Four people in the family. Then if you need any dental work...!!!! $1800 for my last crown. We are no longer talking noise.

8. More litigation... People fall and want to sue so need medical records to prove their claim.

9. More medical tests and procedures - new technology.

10. Doctors afraid of being sued and malpractice insurance going up so running more scientific tests and procedures.

Sometimes I think I just notice these

stories more nowadays because I am working on a

related product.

You are looking for these stories...but there have been stories since HMOs were introduced, and probably before that. There is just more things to report on than there used to be. The situation for the consumer has definitely gotten worse. AND, it is getting worse for the doctor. Some doctors opt out of Medicare or insurance because they don't want to mess with the paperwork and lower payments and delay in payments at their end.

But many of you have been dealing

with these issues for years. What's your

perspective?

- Lisa

Keep on supporting and improving QMEM...the need is only going to grow. I can't tell you how excited I was when I discovered QMEM in March. I have not been disappointed.

Lisa:

I think now is a good time for you to contact the NY Times and discuss QMEM as a solution to the manage the problem of medical bills.

I also think we are looking at our bills now more than ever, because in the 90's we did not have co-pays, our employer paid for our coverage and most of the time doctors took what the insurance carrier paid.

I think another issue is that the insurance companies are denying payments, that should have been paid, and the provider then turns to us. Another mess is the precertification of treatments, referrals.

Gary

PS - If you get the NY Times to publish and article,you have a success story right accross the River in New Jersey. I would be happy to help out, since tracking a family of 5's medical bills is a challenge these days... You may also want to contact The Record in NJ www.NorthJersey.com as well.

Lisa,

Gary & Nancy both make excellent points - esp. relative of the burden caused by HIPPA's regulations. As the article clearly stated, EOBS with cryptic descriptions make things difficult to reconcile. We get EOBs for Home Health supplies. No matter what the charge is - the description is "medical supplies". I don't have a clue whether it's the Zyvex pump bags, Nutren Jr., McKey replacement button, gauze, feeding tubes, syrnges, etc. Sometimes I can tell by the price "billed" but not always. Insurance says that becuase of privacy & HIPPA they won't write anything else on the EOB. We have to have the provider fax us the details.

Lisa - definately have your PR team work with NY Times. I'm sure you have contacts with the Chicago Tribune. Taking my corporate hat off, I do have contacts with some media folks (mostly covering the business and/or book publishing beat): AP, USA Today & Chicago Tribune are those who I know best. A couple names @ WSJ too. I'd be happy to help out in any way. Just give me a buzz or email privately.

Example: Still home health...our daughter's supplies are the same every month: formula, pump bags, oxygen rental; occasionally need other supplies (prn). Insurance will pay months 1, 3, & 4 but deny months 2 and 5. Why? Says we need to submit hospitalization records. There wasn't one. Things got so bad I threatened to send them (at their cost of course) every medical record from the day she was born 10.5 yrs ago. It would make their heads spin. I also said that if I did that I'd want to see every note in their system of all the conversations we had & that everything discussed in the past had been properly recorded. Things started getting paid. Still having trouble with a couple things but the high ticket items (formula & pump bags, etc.) are no longer an issue.

I think another issue is that the insurance companies are denying payments, that should have been paid, and the provider then turns to us. Another mess is the precertification of treatments, referrals.

We must watch insurance companies to insure proper payments. I've learned recently, from friends in the industry, that insurance companies hired by corporations as TPA's (third-party administrators) (mine does)often assigns low/entry level claims specialists to these accounts. I went to HR after being owed >$10k last winter and now work directly with our corporate contact. (it's up there again now & I'm NOT happy). We now scan pt, ot & st claims and send via email to her instead of mailing to the generic po box & I know right away when they're received.

Unfortunately, most of this must take place at the same time when I need to get my work to clients! I also lose precious time w/my family & necessary sleep for me.

Barrie

Barrie:

I'm in the same boat with you on bills, credits owed from providers and FSA account. Since the late 90's I have used an Excel spreadsheet to monitor payments, credits and reimbursements.

I found some providers hold onto the co-pay you pay at the office and the insurance covers it. We have to tell them that we are owed the $$.

Not only is the insurance company having issues, but the staff that collects the co-pays does not know what is covered or not.

Gary

http://www.nytimes.com/2005/10/16/opinion/l16health.html?n=Top%2fOpinion%2fEditorials%20and%20Op%2dEd%2fLetters

see if this link works - letters to the editor from the NY Times article. My favorite is the person who's as cynical as I am & highlights that the longer ins. co's hold on to the $$ the more profitable they are. (interest earning)

Lisa, thanks for posting it in the first place.

Barrie

All the others who replied to your message have given a lot of the reasons for the current mess.

Just watch it get worse when Medicare Part D kicks in! Just choosing the plan under which to get Part D coverage is bad enough; the bill paying end is likely to be nightmare for the first few years at least.

One way in which Quicken as a company could really help is to do what you did with Quicken itself, i.e., become an industry driver in the standardization exchange of medical billing information with customers/patients. If you could repeat the success you had in getting myriad financial institutions to accept a standard way of exchanging data with their customers it would be wonderful. The government is already making noises about standards in some areas of medical record keeping. With Quicken's experience in financial data, I think you should have a good chance of helping not just QMEM users but everyone whose insurers have to exchange data with healthcare provider by applying your expertise in secure data exchange to this problem. I think it would help even those who are not QMEM users because if the providers and insurers had to standardize what the transmitted to users in computer-processable formats, they would have the foundation for rationalizing their printed/emailed output. The market for QMEM could explode if there were a way to receive all the transaction data electronically, leaving all of us (patients, providers and insurers) free to spend our time only on those items which are in dispute.

One way in which Quicken as a company could really

help is to do what you did with Quicken itself, i.e.,

become an industry driver in the standardization

exchange of medical billing information with

customers/patients.

You mean like with OFX and the fact that Quicken doesn't actually support it? As much of a fan I am of MEM, this particular instance with Quicken has not left me with a lot of faith in the company as a benevolent entity. If this isn't what you meant please clarify.

As for your contention that standardization is sorely needed in the industry and the benefits to be realized thereby: You Betcha! :-)

-Tony

as much as MEM & Intuit as a corporate entity can help w/this situation, the product itself & Intuit are not the answer nor solution. Our country doesn't get it. We're all drowning in paperwork, worried about coverage, worried about keeping jobs (or staying jobs) b/c of insurance. Many are being priced out of insurance even if they have a job & companies cover a portion. The article in the NY Times is an opp for QMEM to gain some much desired press and obviously sales so they can make their launch #'s (to fuel prod. dvp $'s for v2 and ensure that the product lives beyond that).

As I said last week, if I ever get to be queen......(don't tell me that blue cross/aetna/pru/etc, etc aren't making $$ hand over fist). They control us. Citizens are also to blame. We allowed it to happen by thinking of medical insuance as a commodity. It's "insurance" & should be as such so no one loses their home. We shouldn't have a system that patient A gets better care than Patient B because they have more $$. But if things don't change soon that's what's happening now. Our friends wanted to use a dr. in Calf for prostate surgery (he's 46) but the doc's fee is $5k up front & doesn't take insurance. (doesn't include hospital, anethesia, incidentals, etc.) $5k for 2 hrs & follow-up.... what % is admin; malpractice insurance; overhead; profit?

Barrie

You mean like with OFX and the fact that Quicken doesn't actually support it? As much of a fan I am of MEM, this particular instance with Quicken has not left me with a lot of faith in the company as a benevolent entity.

Amen!

Hi Markisgold,

I'm not an expert in OFX-related issues, so let me direct you to the Quicken Forum where there seem to be several discussion threads about this topic. <url=http://www.quickenforums.com/category.jspa?categoryID=1001>Quicken Forum is here.</url>

Thanks for being a fan of MEM! :-) I appreciate your business and your posts.

- Lisa

This must be the week for major newspapers to focus on healthcare and insurance -- see the Washington Post article

<url=http://www.washingtonpost.com/wp-dyn/content/article/2005/10/17/AR2005101701285.html>High Deductible, High Risk</url>

The bulk of it is about the cost tradeoffs -- and risks of high costs -- associated with high deductible plans, but it concludes with what patients should expect by way of paperwork and tracking requirements.