Is Your Insurance Company Paying Your Health Claims Correctly?

insurers processing claims incorrectly 20% of the timeThe AMA came out with a report yesterday that said that one in five medical claims is processed incorrectly.  The AMA claims that over $770 million in doctors’ administrative costs could be saved if the health insurance industry improves claim processing by one percent! Keep in mind, this amount doesn’t include the out of pocket money that patients could save if the claim is processed correctly. 

The report looked at seven of the largest health insurance companies for timeliness and accuracy of payment.  Here are the accuracy results of the insurers that operate in Illinois:

  • Aetna                             81.23%
  • Cigna                             84.51%
  • HCSC (Blue Cross)    87.83%
  • Humana                        82.92%
  • United Healthcare      85.99%

This report drives home how important it is for everyone to check their Explanation of Benefits.  Explanation of Benefits (EOBs) are usually sent via mail and can be checked on-line at most insurer’s websites.  They will explain the amount that was charged, the discount that was applied, the amount the insurance company paid and the patient’s responsibility of charges.  Your broker should help you with any claims issues you may have.


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