For example, if a home designer designed a bathroom, and the home owner said “I work from home, and am the primary user of this toilet. I always use the lever to flush the toilet.” The designer finds a standard toilet and installs it in the bathroom. Then the home owner’s wife sees the toilet and says to the designer, “Oh no! It can’t work this way! I use the lever to turn on my sink.” To anyone, this sounds ridiculous. Who uses a toilet lever to turn on a sink? This is akin to how outlandish the insurance payers’ exceptions are that we have to handle in electronic claims processing. We all say “They’ll do anything to deny a claim”, and this couldn’t be more true. They will impose as many exceptions as possible, including not implementing and upholding nationally recognized data standards and identification codes (hopefully more on this later).

Now imagine a complex system where, instead of just the home owner and wife, we have 2000+ insurance payers, 300+ million patients (approximate population of our country), and who knows how many doctors (providers) we have to design for. Try to build a system that accommodates all of these stakeholders, and caters to the insurance payers whimsical ideas of using the toilet lever to turn on the sink.

So when Jon Stewart from the Daily Show scoffed at the Republican side of the debate, saying that their images of insurance business processes and diagrams are “scary looking disingenuous health care reform pop art” I felt compelled to respond. I’m sorry to tell you Jon, that’s what health care is like.

Disclaimer: I’m all for the ethos of universal health care reform, and I believe our country can get there. We just need to give our politicians the time to do their research to come up with a plan that really works.

Related posts:

1. Custom Electronic Claims Processing Module
2. A Solution for Child Overweight
3. Daily Show Barack Obama Circle of Life