Between doctors having to deal with the healthcare claims process and healthcare insurance companies processing and paying the claims, upwards of $300 billion per year is spent. Wouldn’t it be great if there was a way to reduce this not so insignificant figure? This would be a great step to more affordable health insurance plans.

The New York Times is reporting on how instant claims processing works and why it is not being adopted at a quicker rate. Bottom line is that there is an incredible amount of friction on the part of healthcare providers (our wonderful doctors) that is keeping this from becoming a reality sooner.

Wouldn’t it be great if your healthcare insurance provider could process the claim that resulted from your doctor visit before you even left the doctor’s office? Well, the technology exists and is being utilized by some providers, but many are still using the old paper-based system.

Instant medical claims processing works this way: Your healthcare provider uses electronic recorders and inputs the proper diagnostic and/or procedural code into a claims system while they see you. Once the visit is complete, these codes are instantly transmitted to your health insurance provider, whose computer systems instantly analyze the claim and give a payment commitment to your doctor before you even check out.

Because this is an automated process and happens in realtime, there is no need to go back and forth with claims paperwork, reducing the normal 5 to 13 day claims process to mere seconds. This greatly reduces the amount of time, and therefore money, that is used during the claims process. Theoretically this can result in more affordable health insurance plan options because administrative costs can be greatly reduced.

Of course there is one big sticking point to this being widely adopted – your doctors. In case you haven’t noticed, most doctors are working in an assembly line environment, seeing patients as quickly as possible. They don’t have time to know and input the thousands of different codes that are used by health insurance companies, so they let their office staff deal with this process. In order for instant claims processing to work, they doctor has to input the data themselves as they see you, or pay for someone to sit in the exam room with them and do this work.

Unfortunately we are stuck in the Middle Ages when it comes to health insurance claims processing with most doctors offices. Most providers still use paper records which are not compatible with instant claims processing. We have a long ways to go, but someday we will have instant claims processing, which means either your medical bill will be paid before you leave your provider’s office, or you will instantly know how much you are on the hook for that friendly chat you just had with your doctor. Oh joy!

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