Murphy’s Law

Momentum finally is gathering in the health insurance and healthcare industries to develop standardized electronic medical records (see related article, page 11). But, after some recent experiences, I am wondering what it is going to take to really get there.

It started when I got a letter stating that an outstanding medical bill was going to collection. I recognized the provider but was unaware of any unpaid balances. The treatment in question dated back almost two years. However, I had no records or evidence that I had ever been billed by the provider.

So I got on the phone to discuss the matter with the bill collector. However, each time I called, I either got a busy signal or a recording asking me to try again. After a half day of calling, I finally noticed the organization's address, which was in Southeast Florida. That explained it - the day I started calling, Hurricane Wilma hit Florida. OK, I figured, give them a day to recover. But it was a week before I finally was able to speak with a representative.

As far as the bill collector was concerned, the time had long since passed to discuss the history of the claim - nor would it be possible to get a copy of the statement from the medical service provider. In fact, at this point, that provider was no longer involved in the transaction, as it essentially had sold the receivable to the bill collector. My only real option was to charge the balance - then, if I can find evidence that this bill actually has been paid, the collector will cancel the charge.

I'm sure there's a lesson to this whole annoying experience, although I'm not sure what it is. As far as I'm concerned, the provider screwed up by never submitting a bill. Also, the length of time that passed before I got the collection warning makes me think that the provider (or an auditor) recently must have uncovered a backlog of unpaid (or maybe never submitted) bills and had turned to a third party to clean up the mess. Perhaps with EMRs, oversights of this nature can be eliminated. But the hurdles to getting to this ideal state seem huge.

And then there's the matter of what kind of call center backup the collector did (or didn't have) to prepare for a possible natural disaster. But that's a topic for another column.

Katherine Burger is Editorial Director of Bank Systems & Technology and Insurance & Technology, members of UBM TechWeb's InformationWeek Financial Services. She assumed leadership of Bank Systems & Technology in 2003 and of Insurance & Technology in 1991. In addition to ... View Full Bio