Home Health Insurance How Much do I Really Owe? Revamping the Digital EOB

Explanation of Benefits EOB

Explanation of Benefits (EOBs) don’t actually explain much of anything, do they? Most people find them confusing, inconsistent, hard to follow, and full of insurance jargon. What they really want to know is “how much do I actually owe?”

Explanation of Benefits documents come in all shapes and formats, none particularly helpful or intuitive. Most insurers are limited in what they can do with the paper EOB; it is difficult to change and involves many different departments and complex technology. However, when it comes to the digital version of claims information, there is an opportunity to really improve the experience. Dynamic features that aren’t available in a paper-based format can be leveraged online. The ability to provide a more interactive and personalized experience, one that reacts to the varying needs of the user, is a key benefit.

These are a few of the most common complaints about paper-based EOBs:

  • Too much information – the EOB doesn’t focus on the most important details or make them easy to understand.
  • The format is complex and critical information is not at the top. However, based on our research, what is most important is not the same for all users.
  • Accuracy is uncertain – the amount you “may” owe Provider? Should the user trust this information?
  • What exactly is a network reduction?
  • Too much insurance jargon – the terminology is unclear.

With a digital approach to claims information, many of these issues can be resolved. Some of these are “table stakes”, others are items to consider for creating a truly robust user experience in your digital portal.

  • At a minimum, provide an electronic version of the paper-based EOB. This will allow your user to “go paperless” and provide an alternative to receiving paper-based mail.
  • Leverage basic visual cues – horizontal shading for rows, color indicators, icons, etc.
  • Allow users to interact with their claims data in a variety of ways – allow sorting, grouping, and filtering of claims.
  • Be accurate – update the information in as close to real-time as possible with accurate information that ties to the bill from the provider.
  • Be specific – include the actual servicing provider’s information (not the billing provider information – this is commonly a source of confusion), and the actual provider versus the group or facility. Provide service line item level detail. Expose the math behind the calculations for those who want to understand how the payment amount was determined.
  • Avoid jargon – wherever there is complex terminology, allow for contextual help. Include a visual indicator that allows the user to get clearly worded definitions, access to online chat assistance, or a visual tutorial.
  • Understand there are different types of users – some who simply want access to basic information, and those who want to dig deeper. Design the interface with both of these types of users in mind. Create a clear, concise view, but allow for drilling down into detailed information.
  • When a service is not covered, allow the user to get additional information. Tie benefits information to claim details and be specific to their plan.
  • Add visual elements to display out of pocket and deductible information, but give people the option of tabular or graphical – and remember their preference.

To provide a more integrated experience, consider taking on more advanced features such as allowing the user to pay a provider bill directly from the claims information. Companies like InstaMed and banking institutions are starting to provide this capability. In addition, understand that the same interactions and approaches don’t work for everyone. Give people options on how to view information – even to the point of a customizable EOB layout for advanced users.

The online claims summary and detail information can be much more flexible, real-time, and personalized than the traditional paper-based format. Take advantage of the opportunities this channel provides to better service your customers, and reap the benefits of  improving the customer experience, like better member retention and a reduction in call center calls.

Need further proof? Check out the Forrester report highlighting the specific changes Blue Cross Blue Shield of Illinois made to their claims data and the improved experience it created.

Author
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Amy brings twenty years of experience in delivering high-impact, high-value digital solutions, and her innovative thinking has helped numerous health insurers dramatically improve customer engagement. Amy has a long track record of helping clients navigate the consumerization of healthcare - and a long record on the track running half marathons and other hard-core races.

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