Tuesday, December 4, 2012

Medical Claims, Forms and Insurance

I have never had to fill out a form for a medical claim.

Now part of that is that I've never been seriously sick, never broken an arm or a leg, and I've never needed serious medical attention.

Another part is that I live in Canada - where health insurance is free and paid for by the Canadian government.

Thus filling out forms for medical claims to be emailed to insurance companies... well, I've just never needed to do so.

Furthermore when traveling overseas my only worry has been travel health insurance. Which to be fair, I've never been forced to use.

Now there was that one time I nearly fell off a cliff I was climbing in Jeollabuk-do province in South Korea... I was doing some freehand climbing (no ropes) and I slipped, and I could have fallen to my death or at least been seriously injured.

But I didn't fall thankfully.

Also I am pretty fit. I admit I went through a fatter stage years ago, but I've since lost 40 lbs of fat and put on a healthy chunk of muscle. Basically the point I am making here is that I am unlike the typical American, who is either overweight or obese, and therefore has a lot more medical problems.

Thus as a non-American I have never had to fill out any UB04 claim forms. I barely even know what an UB04 claim form is.

Call it a fundamental difference between the USA and Canada. In Canada we have a health card. When we go to a hospital or a clinic we just pass them our health card to prove we are Canadian. Its a bit like having a credit card with unlimited access. In the USA its all about money being funneled through the insurance industry and then they scratch their heads and wonder why health care in the USA is so darn expensive because its never occurred to them to cut out the middle man.

Put simply an UB04 claim form is a very commonly used document in the USA and is a reimbursement claim form submitted by:
  • ambulance companies and helicopter ambulance companies
  • ambulatory surgery centers
  • home health care agencies / clinics
  • hospice organizations
  • hospitals (emergency department, psychiatric department, inpatient, and outpatient services)
  • psychiatric drug/alcohol treatment facilities (inpatient and outpatient services)
  • skilled nursing facilities
  • sub-acute facilities
  • stand-alone clinical/laboratory facilities
  • walk-in clinics
 And so forth. Basically any medical facility in the USA you go to they probably have a few of the forms kicking around.

Now the thing is that companies that manufacture such forms (somebody has to print them out after all!) sell these forms by the truckload to various facilities and insurance companies. Its a lot of paper being wasted, and some of it is presumably recycled, although often such things are placed in warehouses full of records, because insurance companies are perfectionists about keeping old records for everything.

Now the good news however is that some companies are now creating these documents electronically, which means they can also be submitted electronically... Which is great. Saves on postage and shipping costs. Saves on trees too.

Although to be fair, I once worked for a pension plan company, and they also track health claims (because if somebody is off work for 6 months, then in theory they aren't entitled to a pension for that time period unless they can prove an illness or disability with a doctor's note)... And do you know what the company does?

They receive the document electronically and then they print it out as a backup copy (which is then placed in a warehouse full of old records, because pension companies are also perfectionists about keeping old records).

So what is the moral of this story?

Move to Canada maybe? No, not really. We don't really want hordes of Americans moving to Canada. Sounds like a really bad idea.

Is the moral that we do things electronically now, but we still print out backup copies anyway? No, not really. These days the recycling / paper industry is pretty self sustaining.

I think the issue is that some companies are idiots when it comes to keeping records of everything. Sure, the USA needs their UB04 forms for everything because that is just the system they use down there. But eventually they need to start recycling all those old documents in warehouses after 10 or 20 years. Or just get rid of the physical backup copies anyway. Yes, I know, better safe than sorry in case something ever happens to the digital copy...

But to be fair if its stored on warehouses of computers (which I estimate takes up a lot less space than thousands of warehouses full of paper records) the only way those records are going to be destroyed is if there's a nuclear bomb or a flood or some kind of horrific tragedy.

In which case, paper records burn anyway. And water from a flood would likewise destroy them. Thus we would have much bigger worries to worry about than a few lost records from old insurance claims.

Thus why not just go completely digital in the first place? Paper documents will just burn anyway.

Just a thought!

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