A new initiative from the Biden administration aims to quell a varied series of consumer “headaches” by reducing their extraneous time and processes, including for federal employees trying to file health insurance claims.
The “Time Is Money” initiative would touch upon processes across multiple industries that the White House deemed deliberate, time-consuming and burdensome for consumers, such as procuring refunds, canceling subscriptions and filing insurance claims.
The White House has urged health insurers to implement online claims submissions, eliminating the need for paper forms. This request is part of broader efforts by the administration to reduce processes that waste time and money for Americans (see US Health Insurance Market Trends: Rates, Price and Coverage).
The Office of Personnel Management, responsible for managing federal civil services, plans to mandate that Federal Employees Health Benefits and Postal Service Health Benefits providers support online claims submissions. They also aim to improve clarity on in-network health services and simplify the process for appealing claim denials, according to a White House fact sheet. These plans cover 8 mn federal employees.
These hassles don’t just happen by accident. Companies often deliberately design their business processes to be time-consuming or otherwise burdensome for consumers, in order to deter them from getting a rebate or refund they are due or canceling a subscription or membership they no longer want—all with the goal of maximizing profits.
Many of the largest health plans still require policyholders to use physical claim forms, which need to be scanned or mailed, according to a letter from Department of Health and Human Services Secretary Xavier Becerra and Julie Su, acting secretary at the Department of Labor. The departments are asking that carriers give policyholders the choice of online submissions.
The letter, which was sent to health insurance CEOs, said 58% of people with health coverage had at least one problem while trying to use their benefits during the past year, according to Global Medical Trend Rates Outlook. Around one in six said they were unable to receive recommended care due to these problems.
In addition to robbing hardworking families of their valuable time and adding frustration to our daily lives, these hassles cost us money. When, after endless hours on hold or piles of incomprehensible paperwork, we give up pursuing a service, rebate or refund we’re due, we take a hit to our pocketbooks, and companies profit.
The memo detailed plans by the Office of Personnel Management to simplify online submission of out-of-network claims for employees on Federal Employees Health Benefits and Postal Service Health Benefits plans. It also aimed to improve access to information on in-network providers and offer clearer guidance on appealing claim denials (see about U.S. Employers Health Care Insurance Costs. How to Reduce Healthcare Price?).
These proposed OPM requirements are part of a broader initiative to streamline the insurance claims process. The secretaries of Labor and Health and Human Services urged insurance carriers to shift claims processing online, simplify procedures, and enhance access to information and call center response times.
The White House also proposed reforms in customer service, specifically addressing chatbot limitations. While chatbots can be helpful, the Biden administration noted their inability to manage complex issues effectively.
The Consumer Financial Protection Bureau will be working to end customer service “doom loops,” or phone systems that require callers to navigate “a maze of menu options and automated recordings,” according to the fact sheet. The bureau will create a rule requiring companies to give callers the ability to speak with a live agent by pressing a single button.
While CFPB does not have jurisdiction over insurance companies, the White House said the HHS and the Labor Department are also requesting health insurers institute similar changes to make accessing customer service agents easier.
In addition to allowing online claim submissions, the letter also asks carriers to consider presenting information in easier to understand language and offering more details about prior authorization.
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