Why Benefits Management ?
"...For Inpatient Hospital Care and Surgery, acute care for illness or injury and maternity are covered in full when in network and are covered at 80% of reasonable and customary (R&C) charges when out of network"
- a health plan provision
Today, healthcare costs are increasing at an unaffordable rate. Health Insurance companies are trying their best to provide many different health plans and schemes to balance the patient’s need for good health coverage and how much the patient can afford to pay for medical services. However, with all these different healthcare plans and their provisions coming into play, the health plans have become increasingly difficult to understand. Health insurers provide a Health Plan summary document, usually a one pager that gives a snap shot of benefits including out of pocket payment liabilities of the patient.
While making doctor appointments for any particular medical service or going in for medical procedures and lab tests, the patient must refer to the one pager summary to get an idea of the out-of-pocket expenses that will be incurred. However, due to the complex nature of healthcare, and the legalese, there is lot of room for ambiguity and the patient may misread or misinterpret the provisions and make decisions based on his understanding of the health coverage.
"...For Outpatient medical care, calendar year deductibles are $ 1,000 for individuals and $ 2,000 for the family"
- a health plan provision
FolllowUpMD™ BenefitsCentre™ is an insurance benefits management software application which enables the patient with the ability to capture and store in an unambiguous manner all the coverage provisions of the Health Plan summary. The software integrates with the patient health record system (PHR) and provides instantaneous “scope of insurance benefits” feedback while making visit appointments, buying prescription medication or going for health screening tests. The insurer can also benefit by lower benefit administration costs in terms of explanations, analysis etc.
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Although CRM in healthcare is relatively immature, healthcare organizations have an opportunity to differentiate themselves from their competitors
