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Missing the Shoe Box

Digital

Technology – love it! Can’t live without it. But sometimes, I shake my head and wonder if I’m better off without all of these “advancements”—applications—ease of use systems—streamlined access?

Consider, we are only a couple of decades into point-of-sale drug cards and claim submission from the dentist direct to the insurer. Gone are the days of the shoe box and saving up claims for bulk submission for reimbursement. Don’t get me wrong, these advancements are all good. These online, smart-phone services save the consumer—the employee—time, energy, effort, and a lot of times, frustration. The acceleration of claims processing and reimbursement means a claim submitted digitally today can be in the employee’s bank account tomorrow. WOW. That’s fast.

But there’s a cost to the digital age.

The speed of technological advancement has also created an increased claiming opportunity. No missed opportunity. Nothing left in the shoe box. An attitude of entitlement from plan members that “everything” should be claimable, while at the same time, the consumer has lost a fundamental appreciation for just how much is spent on benefits—perhaps billions of dollars each year in Canada because they are not paying out-of-pocket for it first. The direct claim submission has meant a reduced awareness of the actual costs and amount of claiming activity.

Consider how many times I facilitate an employee meeting where the number one rebuke to rate hikes is “I don’t use the plan.” Yes, they went to the dentist twice that year, as did the spouse and children. A few prescriptions, vision and let’s not forget the occasional massage, yet because everything was direct processing, the perception of actual claim activity diminished. What likely amounted to between $3,000-$4,000 in claims had the perception of a couple of hundred dollars because that was all they were out of pocket due to coinsurance. Because there is no little out-of-pocket expense, no one can blame the average employee for this perception. Yet these false perceptions—the lack of awareness of claim activity, devalues the benefit plan overall.

It’s true, digital innovations are transforming healthcare, with huge implications for benefit plan sponsors and the employees they serve. There are estimated to be between 800 and 1,000 health-care-related technology start-ups in Canada today.

The big question is how do employers create an awareness of the plan’s value, while maintaining the ease to which employees have come to appreciate their claims being reimbursed?

Always open to suggestions.


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