September 2016 – Claims Details and Management Resources

The ability for members to view their claims is one of the most important aspects of the online health insurance experience. A health plan’s online claims center provides details that previously would only be accessible on a hardcopy explanation of benefits statement, in a more digestible manner and allows for management capabilities. This month’s Healthcare Monitor Report looks at member site claims details sections, examining these crucial claims details along with the management and help resources provided.

Most claims resources in the Healthcare Monitor coverage group commonly offer basic claims data, a dedicated main menu claims section, printer-friendly options and a link to the explanation of benefits document. Other aspects, however, are less prevalent: Few firms provide direct links to a member claims service message center or contact number or provide claims management capabilities, such as adding claims to groups or flagging claims. Several firms fail to provide details about the claim’s in-network discount amount or neglect to include specific descriptions of healthcare services within a claim. A small group of health plans—Empire BCBS, Tufts Health Plan, CareFirst BCBS and UnitedHealthcare—stand out for their visual representations of financial claims details. Empire BCBS and Tufts Health Plan offer visual breakdowns of individual claims by health plan financial responsibility and member financial responsibility, a useful element that may help members understand their insurance benefits and costs. Similarly, CareFirst BCBS and UnitedHealthcare, two of this report’s top health plans, offer a graphical summary of all claims within a coverage period, including such information as plan discount, amount paid by plan and amount paid by the member. Ultimately, insurers should provide access to a broad range of self-service features on their digital platforms, including claims reporting and payments, which were only provided by one health plan in the Healthcare Monitor coverage group.