Simplee Stories & News

Simplee Stories & News

Simplee’s Automatic Error Detection Saves Users Thousands of Dollars

Have you had a chance to check out Simplee’s error detection feature yet?

We’ve been hearing from many users about how they’ve saved money or solved billing problems.

First, there was the user who told us he fixed a billing problem in ten minutes, after fighting his insurance company about it for the last four months.

Another user tweeted that he found an error that saved him $1,000.

And then, we interviewed another user who saved over $1,000 on several medical bills just by checking for errors. He said this didn’t even count another several thousand he saved by repeated calling out a separate error: His insurance company denying every claim because it believed he and his family had a second insurance plan that should be paying.

Using Simplee has made it easy for him to spot this error, plus additional ones such as duplicate claims or the incorrect insurance carrier being billed. He then uses Simplee’s notes feature to track the status of claims he’s disputing, so he knows not to pay them yet.

So far, he’s found that over 70% of the claims for himself, his wife, and two kids, contained some kind of problem that needed to be addressed before he paid the final bill.

To review your own account, log in to Simplee and look for our red, orange, and green flags next to a claim. These flags will tell you when we think we’ve spotted a problematic claim or a tip for saving money.

Do you have a success story about using Simplee? Let us know! Your tips could help other members save.

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Simplee Now Automatically Screens Your Claims for Billing Errors

Are you ready for an exciting new feature?

We know how painful it is to read through medical bills to make sure you were charged the right amount for the right services. And how even more painful it can be to not read through them and just pay what’s on the bottom line (hoping that you’re not getting screwed).

We’ve been thinking about ways to make it easier to understand your bills—and we came up with a feature that automatically reviews your EoBs (Explanation of Benefits) for some of the most common billing errors, reasons insurance didn’t cover a claim fully, and even strategies for how to save money in the future.

Now, when you get an email from Simplee about a new claim, it will include color-coded flags next to claims where we have identified a potential problem. Click on the claim, and we’ll explain the problem and what you should do next.

We’ve seen an average savings of about $91 on claims that the feature has flagged. Although one user who spotted a billing error through Simplee saved almost $1,000. Our hope is that this new feature will encourage everyone to start looking more critically at their claims and benefits and find ways to put more money back in their pockets.

Studies have found anywhere from 40%-80% of medical bills containing an error, so it’s worth taking a second look, right?

Some of the issues that Simplee will scan for include out-of-network claims, benefit limitations, claims for services that were previously covered, prescription drug costs, and a lot more. Learn more.

What billing errors have you noticed in your EoBs? Let us know at support@Simplee.com so we can start spotting them for you.

Here’s what you’ll see in your email. Keep your eyes out for it!

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Simplee Helps Craig L. Save Almost $1,000

I wish I had some video of the silly dancing and cheering we were doing around the office when we read this great letter from user Craig L. about how Simplee saved him almost a thousand smackeroos!

Hi there.  I quickly wanted to share my Simplee success story.

We have a son with a disability and he receives many different therapies.  I get statements from our insurance provider, but cannot often make heads or tails of what is being reimbursed, at what rate, and why.  With the help of Simplee, I was able to catch a $968 error.

It turns out that for a particular therapy, we were being reimbursed at the in-network 90% rate up through the end of last year.  At the start of this year, for some reason, for this same therapy, we were being reimbursed at the out-of-network rate of 70%.  Given the complexity of statements, I didn’t catch this on my own.  Armed with the simplicity of Simplee, I was easily able to see the discrepancy.

I called the insurance provider and pointed out the error.  They acknowledged the issue and sent us a check for $968.

Without Simplee, I would not have caught this on my own.

So, thank you very much for saving me a ton of money!!

Thanks, Craig!  We are so thrilled we could help you and your family.  Hearing stories like this makes all the hard work completely worth it.

If you’re not using Simplee yet, why the heck not?  Sign up and see what you can save.

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From the Simplee Community: “I was blind and now I see!”

Many thanks to Raymond (@nanao56) for writing us this story about how Simplee helped him finally understand his healthcare expenses:

I was blind. I just paid what looked like a bill. Sometimes, I was told I was past-due even though I got prior notices from my insurance company stating they were covering my bills. There were times when I just didn’t understand why I was paying for a service when I thought I was 100% covered.
This all changed recently.
I heard (in a tech competition) about a new web service that will aggregate medical claims into one view! The dog and pony show for this new service made it look like I could now be intelligent about what I’m paying. I signed up, but I could not connect to my health provider.
From a recommendation, I then heard about Simplee, so I gave it a try.
I was amazed; within hours, it pulled all my information in and started to categorize the information.
It was cool. Aside from the dashboard that quickly provided a snapshot of what I had paid for the year, it helped me understand each of the billing items and made me squirm to think of how much lack of information I had before on what I was paying.
To me, Simplee is the Quicken/Mint of Health Care. The ONLY cool thing about paying a health bill is the Simplee experience!
Thanks Simplee, I look forward to the service growing.
Raymond
To experience how easy your medical bills can be with Simplee, get started today with a free account.
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When A Patient Becomes A Medical Billing Expert

Guest post from clearhealthcosts.com– We’re bringing transparency to the health-care marketplace.

Unusual billing practices from hospitals are the topic of this piece, written by our friend iPatchman. He received a master’s degree in health policy management and economics from the Columbia University. He currently has his own health-care consultancy, Health2Social.

Consider this a lengthy but cautionary tale. I just spent two hours going back and forth between my provider and my insurance vender trying to decipher a health-care bill. I was trying to figure out why my doctor billed me $441.58 for a service date, when my insurance company claimed I owed only $131.99. I had originally called the hospital  because I found it odd that they were billing me an amount that was much more than the difference between what they billed my insurance company and what they received as payment. (As discussed in previous blog posts, the amount a patient owes in-network is usually a co-payment or co-insurance based on what the insurance company contract with the provider determines is owed for the service.)

It usually goes something like this:

Covered Amount = Amount Billed to Insurance – preferred provider or network discount. The covered amount is then divided into what the insurance will pay and what the patient owes.

In my case, I pay 10 percent of the covered amount (my co-insurance), so it would be: Covered Amount – (% co-insurance*Covered Amount) = Amount Paid by Insurer to Hospital.

The hospital wrote on my bill:

Amount Billed to Insurance ($1204.00) –Insurance Payment ($1083.61) =

Amount Owed by Patient ($441.58).

Now, anyone can see that the difference between the billed to insurance and amount actually paid by insurance is only $120.39 (the maximum amount owed to the hospital for my visit), and that is without taking into account any PPO discount, which lowers the amount further. Still, my doctor’s account representative insisted that this $441.58 is the amount based on theexplanation of benefit (EOB) from my insurance vendor, so that is what I am being billed. I tried to explain that it negates any logic that the amount my doctor is billing could be more than three times the amount the hospital is even owed — but my logic fell on deaf ears.

The hospital also refused to contact my insurance vendor to look into this matter, saying it is the patient’s job to do this. I decided to hold off on explaining that it is not the patient’s job or place to coordinate between the hospital and the insurance companies (which is the exact reason billing departments exist at hospitals) since I wanted to call up my insurance vendor myself to get a copy of the explanation of benefits.

From my education and work background, I have analyzed health claims for hundreds of thousands of employees from dozens of  Fortune 500 companies. This is why I never pay any doctor or hospital bill until I review it and compare to the EOB from the health plan. I cannot imagine how most people, who do not have the health-care education or work experience I do, deal with their health-care bills. I catch mistakes by the health plans and the hospitals all the time, and most times they are for hundreds of dollars.

After obtaining the explanation of benefits from my insurance vendor I was left with the following explanation:

Charges Billed ($1629.54) – PPO discount ($309.59) = Covered Amount ($1319.95),

and

Insurance Payment ($1187.96) + Patient Responsibility ($131.99) = Covered Amount ($1319.95).

This now makes sense as my responsibility was exactly 10 percent of what my insurance company decided was the covered amount. Still, when I asked my insurance company to send this information to my doctor, the representative said they had already done so, and had already paid, so they would not do it again. They were willing to fax me a copy instead. Again I encountered the misconception that the patient is somehow responsible for communication between the hospital and insurer. In this case, though, I wanted to call my provider back anyway because I need to understand where their mistake was.

Calling back my doctor did not result in any productive conversation as the representative was only able and willing to read back to me what they had in their system. I tried to explain again, but got nowhere. When I asked my provider to start an inquiry into this matter, the rep told me to ask my insurance company to send them the EOB again.  I politely explained that I can make a few phone calls, like I did, but I cannot facilitate the communications between the hospital and insurance company and that is what they were for. I also explained that this practice of billing a patient a large amount that was not owed was either criminally negligent, or fraudulent, but in either case I expected a full inquiry into this matter (mind you, my provider mostly deals with patients with cancer – patients who have enormous health-care bills, not to mention plenty of other things to worry about). I asked her to have someone in a management role in the billing department call me back, but she responded that they do not call back anyone. She said I can call in 7 to 10 days to see if there was an adjustment.

When I asked if they had received the fax with the new EOB I had sent them, she responded that it takes 24 hours for them to receive the fax digitally into their system. This cracked me up, since not only do they require patients to use an anarchic method of communication, but they do not even really have a fax machine, and instead use the digital system to receive faxes (which makes you wonder why I could not e-mail them the EOB).

The takeaway lesson here is simple.

Think carefully about automatically accepting or paying any bill you receive from a health care provider. It’s only prudent to review and compare all bills to your plan’s explanation of benefits.

*  *  *  *  *  *

More from clearhealthcosts.com:

How much does an M.R.I. cost? The view from the medical billing office

Mammogram costs: A Boston-New York rivalry

Why so many angioplasties? A mystery story

Like us on Facebook; follow us on Twitter.

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Spendwise Dads Love To Keep It Simplee

Reposted with permission from Spendwise Dads.  Thanks, Drew!

When we found out that my wife was pregnant with our son, we were in Colorado Springs for a summer internship. She began going to a doctor in the Springs, but in August we moved back to Utah for school and had to switch doctors. The bills and Explanation of Benefits (EOB) documents that accumulated from numerous visits to the two different doctors as well as blood labs, the hospital, and the anesthesiologist, who all billed us separately, were almost impossible to keep organized. We were still receiving EOBs and bills from the original doctor in the Springs months after our son was already born.

Presumably the EOBs are there to help you reconcile what the insurance paid on your behalf and how much you own out of pocket to the doctor or hospital. In a couple of instances, these documents helped us make sure that we weren’t paying for something that we didn’t actually owe and we were able to get a bill corrected. But in general it was difficult to keep all of these things straight and feel confident that we were on top of everything. The EOBs showed up in the mail in what seemed to be a random order. Sometimes we received duplicates or updated EOBs with corrections that we knew nothing about. By the time we received our last EOB related to this birth, we had enough pages to fill a 3-inch binder. We did our best to match EOBs with their associated bills, but to this day, almost two years later, the only thing that reassures me that all of these accounts were reconciled is that we have stopped receiving documents in the mail, we haven’t received any calls from collections, and our most recent credit reports don’t indicate any issues.

Enter Simplee.com

Oh how I wish Simplee were around two years ago for that pregnancy and birth. I just started a full-time job with benefits in May and have since been using Simplee.com to keep track of our, so far, very few health insurance claims. If you are familiar with the Mint.com, you will recognize the concept: Simplee uses a secure connection to link to your health insurance web site and access the claims information directly. This information is organized and displayed in an easily accessible and easy to understand way. Our insurance provider now provides our EOBs online so that we no longer have to massacre entire forests just so that we can receive a physical copy of the same information. These generally come in PDF form and are not easy to organize without printing them out. Simplee makes the process of reviewing and even adding notes to claims…well…simple!

As you might expect from a small start-up, they do not yet support every insurance provider in existence and they are continually working on adding support for more providers. They currently support our health insurance and dental insurance, but not our vision or prescription.

I’m sure as this site grows more providers will be added as well as great new features to help all of us keep on top of our health insurance claims. I would recommend this tool to everyone.

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Simplee member offers tips for better dental care

Whenever we are tell people about Simplee, we are struck by how everyone seems to have some story about getting overcharged by a provider, rejected by an insurance company, and generally bumped around in a system that is decidedly customer unfriendly. 

Today’s story comes from Simplee user David of Sunnyvale, CA:

We all know that planning can be very effective. It is especially important when it comes to dental insurance. Since most dental insurance (including mine) has an annual cap, making sure this cap is used in the most effective way could save you big bucks.  I always heard stories from friends about the thousands of dollars they paid out of pocket for their dental treatment, and now I know why.

About 2 years ago my dentist told me I needed a root canal and a crown.  These two treatments are very expensive, with costs ranging from $1,000 to $1,500 each.  Put these two together and they can easily surpass the cap on the annual dental insurance allocation—mine, for example, was $2,000.  Once your cap is met you need to start paying for treatments out of pocket.  So since it has been the end of the year, I scheduled the root canal right away and the crown for the beginning of the year.  The expenses fell into two different years so I stayed below my cap.  I still had to pay the deductible of the treatment but I probably saved hundreds or even thousands of dollars.

A few lessons I learned from this:

1) Track your dental spending for each family member

2) Plan ahead and be aware of your annual cap

3) Make sure that for major treatments, you submit a pre-authorization to your insurance so you know exactly how much you will pay for the service before you start with the treatment

Thanks for sharing again, David

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One Patient’s Story: the Cost of the Surgeon’s Glue Gun

Whenever we are telling people about Simplee we are struck by how everyone always has some story about getting overcharged by a provider, rejected by an insurance company, and generally bumped around in a system that is decidedly customer unfriendly.

This story comes from Baat, who was pretty surprised when a doctor turned “surgical adhesive” into “surgery” and charged her $900 to fix a small cut on her son’s head.

Our story begins last March, when our 5 year-old fell and bumped his head on the ground. Nothing major, a little bit of blood, but I decided to take him to the Palo Alto Medical Foundation Pediatric urgent care, to clean it properly, and evaluate the damage.

We were seen first by the assistant, who cleaned and inspected the wound, and then the doctor examined it and determined it to be a minor gash. She also performed a physical examination to make sure no additional issues were caused by the fall (concussion, motor skills, etc.).

Since the wound was still mildly bleeding, we were offered to have a small amount of glue applied to his injury, as it was too small for stitches. The alternative was a bandage, but that seem difficult to keep in place on his head, so we asked for the glue. The actual procedure took about 5 min (although 15 min was spent waiting for the local anesthetic to absorb to take away the sting of the glue). Our entire visit (most of it spent waiting) was under an hour.

We currently have a High Deductible Health Plan (HDHP), which means this type of treatment comes out of our pocket. I was therefore curious to get the bill, hoping it wouldn’t be high.

A few days after the treatment I received an email from my Simplee account. I was shocked to see the bottom line: $888. In addition, we noticed the insurance company classified it as “surgery”.

Being notified so close to the event by Simplee (rather than waiting for weeks for the bill), while I have all the details fresh in my mind, helped us compose a letter to dispute the charges with the care provider. We basically wanted them to classify the treatment differently, since we didn’t see how a situation that was offered a bandage as a treatment, could become so expensive, and carry the title of “surgery”.

Today, our case is still in dispute, but last I heard from PAMF, they will change the classification of the bill.

In an ideal world, knowing (even ball-park numbers) how much a visit to the doctor could cost us, or the cost of using glue versus a bandage, would empower us to make better decisions. Had I known such a visit would result in hundreds of dollars, I probably would have cleaned the wound myself put a bandage at home.

From a financial perspective, doctor visits feel like walking in the dark. You have no clue of the associated costs, and you let the care-providers and insurance companies run the show. But as we are encouraged to move to HDHP, and incur more out-of-pocket costs, creating a more transparent system is crucial.

Simplee’s approach, of notifying users quickly after events occurred, and having all the details in one place, showing costs, where the money is going, and hopefully one day alternative options, is a big player in empowering health-consumers. This bottom-up approach, letting users have the information they need to make smart decision is an important step in fixing this broken beast we today call “our health and insurance system”.

One way of looking at this is to say the system is working—the idea behind high-deductible plans is that by pushing more of the expense on consumers they will make people pay more attention and drive costs down.  However, as Baat points out, the consumers in this equation have very little information and very little power.  Finding mischarges takes time and attention, and fighting them takes tenacity.

Simplee can’t change what providers charge, but we do try to make it easier for you to dispute claims.  Next to each claim detail we provide the contact information for your provider and your insurer so you can contest the bills you disagree with.  And of course getting the info in a clear and timely manner is very helpful.  So make sure to check each claim as it comes in to see that everything is kosher… and surgery-free.

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Thanks to the “Love That Max” blog!

Many thanks to Ellen Seidman of the blog “Love That Max” for mentioning Simplee in a post last Saturday.  Who are Ellen and Max?

Some people look at Max and see only a child with disabilities, I know. But there are many, many Max miracles. The little ones happen whenever he says a new word or sight reads a new word or runs down our block, doing stuff doctors never thought he would. It’s also a little miracle every single time he smiles—I swear, sunshine shoots out of that kid.

And then, there are the big miracles. Like the fact that a doctor told us we could sign a Do Not Resuscitate at Max’s birth and now, look at him. And how much progress he’s made, and keeps making. And, most memorable of all, the day he took his first steps. That was Miracle Day.

When you work at a start up there are a million different things to focus on every day—emails and metrics and stats and tasks and presentations and meetings and all the little things that keep a day busy.  And then you read about Ellen and Max and you remember what it’s all about.

At the end of the day, we here at Simplee are excited to be creating something that helps real people solve real problems.  Dealing with medical bills is such a huge pain point for so many people, and it is all the more so for those who, for one reason or another, have a lot of them to deal with.  We are glad to be able to make at least one part of their lives easier.

Thank you, Ellen and Max!

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From the Simplee Community: “Simplee Has Made It Very Clear To Me.”

Many thanks to Simplee user David for writing us this story about how Simplee gave him peace of mind after the birth of his new baby:

As my wife was going through her pregnancy for the past 9 months, many things went through my mind.  Of course there was joy, excitement and great anticipation of the big day, but there was also anxiety.  We didn’t know if everything would go well, if the baby would be healthy, if we would need a C-section, or if we would have problems dealing with insurance.  The cost of everything would be so high without insurance paying for it.

I was very excited when I first read about Simplee on TechCrunch.  I thought that health insurance simplified would be great.  I already have similar service for banking (Mint) and I was very happy with them, so I jumped on the chance to get into the private beta.  It worked just like I thought it would.  Bills charged to my health insurance would show up on Simplee, and it was very clear to me whether or not a claim was successful, or if it was denied for whatever reason.  It would also tell me the amount that I am responsible for paying in every claim.  If a claim was listed as denied, it would state the reason and show clearly that I was not responsible for paying the rejected amount.  It definitely gave me peace of mind that I understood the claims, because reading the health insurance statements directly, they make things so complicated!

During the week after the baby’s delivery, you can imagine that everything was very hectic.  Relatives visiting, bringing the baby home, taking care of my wife, visiting the pediatrician for the first time—the last thing we wanted to worry about is whether or not we would be charged tens of thousands in bills.  Thankfully, Simplee has made it very clear to me what is going on.  I would definitely recommend everyone join Simplee to get an understanding of your health insurance.

Thanks for the kind words, David, and congratulations on your new baby!  To experience how easy your medical bills can be with Simplee, get started today with a free account.

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