The first health insurance cards were probably introduced by Blue Cross Blue Shield in the 1930’s as their number of “covered lives” rocketed to over three million participants. Over the next eighty-five years the health insurance card became a fact of life. It is now a necessary token to obtain healthcare services in every context.
It is not uncommon to have at least five or more providers over a ten-year period who need to scan or photocopy your card, as well as recheck your status on each visit. The increasing drive to specialization is only increasing this number.
Last year I received three new insurance cards containing ostensibly the same information. I was not notified of the reason for the re-issue, nor was I told of any difference in the enclosed information. I paid for these cards through my premiums and remain unimpressed with the extreme waste and cost of repeat mailings to millions of subscribers.
This lump of paper or plastic is an easily forged opaque key to healthcare services. As WebMD says, “Your insurance card proves you have health insurance services”, a statement that is probably true in the rare situations where pre-authorization is not the actual proof. Since cards rarely – with the laudable exception of those issued by the Veterans Association – contain photos or other biometrics misuse is simple.
If you are lucky your card will be sent out at the start of your policy period. If not, you could be in trouble, because many providers will refuse to see you, or will charge full price for any services. There have been high profile reported cases of waiting weeks for a new card, during which medical services were cost prohibitive.
“If you didn’t get or lost your health insurance card simply call your insurer and request a copy, an insurer can tell your info and fax a copy to your doctor.” – Obamacare Web Site
In theory your card has your copay information written on it, though as a high-deductible plan member many of my providers cannot seem to work out what the correct co-pay should be. Ideally they check if I’ve met my deductible on the insurer health site but that doesn’t always work. If we get past this hurdle they then must decide if I am paying a copayment or am using coinsurance. Again, this rarely goes well. More often that not, a blank look settles in on their face, and they agree to bill me; a practice which most healthcare businesses despise due to the increased likelihood of not being paid.
The current situation is absurd, cumbersome, and in drastic need of change. How is it that I can go to Starbucks and buy a latte with my iPhone, yet my providers need to see a small plastic or paper care before they can manually enter a subscriber number into a web site?
Were we to have another round of funding for an act like HITECH, I would propose that one of the simplest steps that could be taken to improve the patient experience would be the upgrade of the Point of Sale (POS) systems that exists at most doctor’s offices so that they can handle near-field data exchange and smart card swipes.
We also need legislation requiring health insurers to provide smart cards to all their members. Note that regular credit cards would not work, because the PCI regulations about what data may be stored on track 1 and track 2 are prohibitive. If you are interested in how this could work in practice the Smart Card Alliance has a comprehensive document that can be found here explaining the benefits as well as the barriers to entry.
Imagine the margin insurers could recoup were they to use SmartPhone apps for 50% of their population. In one fell swoop they gain a way to easily update health insurance information without printing more paper or plastic cards, plus a way to communicate key health information to their subscribers.
Some insurers are doing this today in limited ways – for example, Anthem BCBS has a a smart phone app that allows you to securely view, fax, or email your card when you need to. It’s a start, albeit a clunky one as you must first open the app, enter the fax or doctor’s secure email address and then wait. Near-field would be much better.
The cost benefit analysis is so obvious that it’s hard to understand why every payer isn’t doing this today. Perhaps this is simple inertia, there’s so much to do in healthcare that some of the more obvious ideas are getting insufficient attention.
In ten years the current health insurance card situation will be seen in a Proustian light and many will question how such a arcane system came to be. As the Secretary Burwell looks for the new initiatives in healthcare that have been asked of her by the senate, I hope the ideas in this article might be up for consideration.