The secret to paying faster claims
Using technology to build a better claims experience has been on every payer’s radar for years. We have web portals and apps galore. So why do supplemental health claims still take weeks to be filed and even longer for benefits to be paid?
The secret is that technology alone won’t allow us to pay supplemental health benefits in hours or even minutes. We need to start thinking differently if we want to create a better claims experience. Here’s how I arrived at this conclusion.
Why pay claims faster?
If you have a supplemental health insurance policy, the moment your benefit payment hits your bank account is the most high-value moment in your journey. It’s the moment when you receive value for the premium dollars you’ve paid for the coverage. It’s also a cash influx that comes when you or a family member have had a health issue and the bills have started showing up in your mailbox. It’s a moment of relief.
When we built Brella, we knew we could deliver 10x value by making it dramatically easier and faster for our members to arrive at that moment.
Sure, updating the old paper forms and faxes into a digital experience is a good place to start. But technology alone wouldn’t allow us to pay claims as quickly as we wanted to. In order to get even faster, we had to look more closely at the problem.
Why do claims take so long to approve?
Think about the anatomy of an insurance claim. As the payer, you need to know what happened, you need to see the evidence or “proof of loss”, and you need to apply that information against your policy to determine whether the claim is payable. Lastly, you need to issue the payment. So, the typical claims journey might look like this:
Technology can do a lot to expedite some of the stages above, particularly starting the claim and submitting it to the payer. Electronic payments can help get benefits to members quickly. However, those stages combined are only about 20% of today’s typical claims timeline. If your policy requires “proof of loss” documentation from the member’s provider or health insurer, your member may have to wait days or even weeks to gather the evidence you require to support the claim.
So now that you have a better idea of the problem, you might be asking, “How do you address the time it takes your members to gather evidence?”
It will be challenging to influence providers to file claims with the health insurer faster. You have no control over how quickly the health insurer adjudicates the major medical claim or issues an EOB to your member. Here are a couple of ways we got around this problem at Brella.
Two non-tech tactics to speed up your claims process
First, take a hard look at your benefit triggers.
If the trigger for a benefit is a particular treatment or healthcare service, you’re going to need provider or insurance documentation for care that happens later in the member’s journey. That could leave them sitting with big bills to pay while they wait for their supplemental benefits to come through.
At Brella, we designed our supplemental health insurance plan to pay benefits based on the diagnosis of a covered condition. We don’t need to see evidence of treatment and we have no accident or hospitalization requirements. If you have a concussion, that’s a Moderate covered condition, so you’d get your plan’s Moderate benefit payout. All we need is the ICD-10 diagnostic code, which can come on, or be deciphered through, provider paperwork much earlier in the healthcare journey.
Second, think about how to simplify claims adjudication.
We now live in a world where property and casualty claims can be auto-adjudicated in seconds. But supplemental health plans haven’t made this leap. Why? Payers can’t automate adjudication if their policy requires proof of the circumstances of the health condition, the condition itself, and specific treatments. Our policy simply requires a covered ICD-10 diagnosis code, which paves the way for auto-adjudication of claims.
Brella’s typical claims journey looks more like this—
Imagine being able to file and receive a supplemental health benefit the same day or—for that matter—in minutes? What would that mean for your willingness to go get care if you’re sick or injured? What would it mean for your health plan choices during Open Enrollment? What would it mean for your HSA and your savings account balances?
Paying claims faster requires both insurance and technical innovation
This is why we’ve argued that insurance experts and technologists need to work together to design benefit solutions that truly meet the needs of today’s employees. Digital member tools alone aren’t going to deliver a 10x more valuable experience—and employers and brokers shouldn’t be impressed just because an insurance product has an app.
Our insurance experts redesigned our plan to both simplify our requirements for proof of loss and streamline our adjudication process after the claim is filed. Those changes unlocked opportunities to use technology in new ways to further accelerate our claims process.
By working together, our team designed a benefit solution that not only covers more than any other supplemental health plan on the market, but also it delivers a member experience where benefits are paid in hours, not weeks.