Healthy, Wealthy and Wiser

By Edward H. Baker  |  Posted 11-01-2004

Over the course of the past two years, I've had to submit regular monthly claims to my health insurance company, UnitedHealthcare, for doctor's visits related to a recurring medical condition. Eventually, all the claims were paid, but the effort involved in getting the insurance company to cough up the money almost drove me to an early grave.

Just three of the 14 claims I filed were paid on time. All the others required numerous phone calls, follow-up phone calls with clerks who had no record of earlier phone calls, the re-filing of claims forms said to be lost, and checks mailed to the doctor rather than to me. One clerk suggested I fax my claims forms, but it turned out that the fax went to Texas, where they put it into an envelope and mailed it to Utah, which took longer than if I had mailed it to Utah in the first place. Never once was a fax acknowledged by phone, as promised; never once did I receive a follow-up phone call from a supervisor when I asked for one.

I can only hope my experience was exceptional, and I am not so cynical as to suggest that United's treatment of me was intentional (though I frequently hear from doctors of the unwillingness of insurance companies to pay claims). Administrative ineptitude seemed the most likely cause—that, and the company's glaring lack of process automation. Still, the endless hours spent on the phone (most of the time on hold) did stick in my craw. Why, I wondered, is the healthcare industry so painfully bad at taking advantage of information technology?

This month, Contributing Editor Jeffrey Rothfeder looks into that question. His report, beginning on page 56, makes clear that the industry—and not just the private insurers—desperately needs more and better IT. But it also makes clear that IT alone isn't the cure, and won't slow down the double-digit rise in healthcare costs. No real cure will be found until the various competing players involved—the hospitals, doctors, drug companies, public insurers, private insurers, employers and patients—can align their interests in a logical and equitable way.

Meanwhile, rather than paying my premiums to United, I should have invested that money in their stock, which in the past five years has risen from about $13 a share to more than $80. With luck, I might have gotten as rich as Dr. William McGuire, the chairman of UnitedHealth Group, who last year made $10 million in salary and exercised $84 million in stock options. Then I wouldn't even need health insurance.