CareFirst BlueCross BlueShield wins award for confusing statement | Washington Business Journal

Which form do you think is easier to understand: Tax instructions from the IRS or an explanation of benefits from CareFirst BlueCross BlueShield?

The IRS instructions, by a long shot. So says the Center for Plain Language, a Silver Spring-based nonprofit dedicated to the cause of ridding the world of unnecessarily complicated legalese.

CareFirst won the center’s 2011 WonderMark Award, given for the “least usable document.” Specifically, the insurance company won for a standard explanation of benefits document sent to a Maryland customer.

Meanwhile, the IRS won the center’s grand prize ClearMark Award, given to the forms and websites that best use plain language to communicate with users. Specifically, the center praised the IRS’ easy-to-find instructions, “active voice,” and effective use of the pronouns we and you to “clearly and personally identify the party who has the duty.”

Though it doesn’t dwell on CareFirst’s shortcomings, the explanation of benefits displays none of those qualities.

A CareFirst spokesman has not yet returned an email seeking comment. In fairness, it’s worth noting that some of the confusing language in the insurance document is required by Maryland law. So while not entirely blameless, CareFirst is just following orders from an equally confusing bureaucracy.

benfischer@bizjournals.comor 703.258.0828.
Twitter.com/fischer_biz

In HealthCare the EOB is too often an oxymoron. Neither an explanation Nor a Benefit.

There is so much to be done in this space. We need to crowd source solutions since so many of use receive these currently useless documents.

Who do you think provides the best example of an Explanation of Benefits (EOB)?

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2 thoughts on “CareFirst BlueCross BlueShield wins award for confusing statement | Washington Business Journal

  1. Carefirst is by far the worst insurance company in the world. Yes, their documents are confusing, but try calling their Call Center to resolve a claim. Half the time you’re directed to the wrong extension, or it’s too confusing to even figure out which option you want. They administer not only Carefirst patients, but if you’re a provider’s office unfortunate enough to have Carefirst as your local BC/BS plan, they administer ALL BC/BS claims. I’d say a good 10% of my time is spent on the phone trying to figure out why a claim wasn’t paid — and it’s CAREFIRST that usually bungles them, or has some arcane rule about how the claim was supposed to be paid. They do not accept electronic secondary claims, so there goes another 5% of my time, creating, printing, and mailing claims for those Medicare patients who for some reason or other can’t get their secondary claims automatically crossed over. You’d think they’d have figured out how to make THAT work with all their money but no. If they didn’t have such a corner on the market — and here’s proof that bigger is NOT better — we would drop this insurer faster than you could say CAREFIRST? NO, CARE LESS. On the other hand, Medicare claims are easy to file and their EOBs are easy to understand. I can get someone on the phone quickly, or get my questions answered online. So much for private insurance being "better" than government run plans.

  2. As far as who provides the best EOB? MEdicare, Maryland PHysicians Care (a Medicaid HMO here in Maryland), Wells Fargo, Highmark West Virginia, and United Healthcare. What I want to know, is why aren’t these standardized in much the way the claim forms have to be on a CMS 1500? It would make a biller’s life so much easier. One more thing about Carefirst and then I promise I’ll shut up. Most insurance companies mail a check that’s attached to an EOB. At least one of Carefirst’s entities will mail the check, and the EOB plus 5 or 6 sheets of paper accompanying the EOB that are totally unnecessary. I wish they’d save some money on paper and pass on the savings to their patients.

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