Back in February my son lost control of his car and landed in the hospital. Fortunately he has recovered from his injuries. And fortunately we have health insurance. So everything’s OK. However, I’m still — six months later — trying to untangle the bureaucratic mess that ensued.
There are multiple insurance providers (auto, health) and healthcare providers (hospital, clinic) involved in this game. None of them talk to each other directly. They all emit tokens, in the form of images of documents, that the consumer — me in this case — has to decode and route.
Recently, for example, I realized that while the bills from the clinic had been routed to the health insurer, the bills from the hospital hadn’t. Why not? A token wasn’t properly routed. The name of this token is Exhaustion of Benefits. In this scenario, the auto insurer pays for the first round of bills, up to a limit. When that limit is reached the auto insurer sends the insured party an Exhaustion of Benefits letter. It must be routed to all the health-care providers to trigger resubmission of bills to the health insurer.