WTF Denied: Explaining benefits better

2013 Oct | Side projects

⊕ Impact.

A project at the Health 2.0 Code-a-thon: Power to the Patient. Winner of the EOB Redesign Challenge, 2nd place overall.

OMG WTF EOB!

Explanation of Benefit forms (EOBs) are the bane of many a patient with complicated healthcare costs. These forms ostensibly outline the costs a patient is being billed for as well as the costs covered by their insurance plan, however they are consistently difficult to parse. On top of their inscrutability, EOBs frequently contain problematic or mistaken information, and patients are left with only the insurance company itself to rely on to resolve them.

A two-pronged approach

Our solution was twofold: First, redesign the EOB itself, so that patients can better understand the information they have been presented with. And second, provide a community where patients can draw on their collective expertise to deal with further questions and problems.

Redesigned EOBs

Using actual patient EOBs as well as example forms, I redesigned the layout and visual language of the form to more clearly present the information needed by patients.

Adding a summary of totals from the list of claims contained by an EOB.
Presenting the plan benefits summary in a more visually understandable fashion.
Surfacing human-readable explanations rather than opaque medical codes.

This layout is enabled by expanding the Blue Button Plus standard to accommodate structured EOB data. For the design language I adapted Jackson Wilkinson’s redesigns of the Electronic Health Record.

Connecting a community

When patients receive confusing or erroneous EOBs, their only immediate recourse is the insurance company itself - often the very institution they feel ignored and oppressed by. Presently, patients already try to adapt ill-suited online spaces to share experiences and advice (twitter, reddit, change.org).

We created an online community specifically for EOBs, where patients can upload and organize their own EOB data, and where conversations can persist in a useful format.

Team: Amy Gleason, Ashish Patel, Lauren Still, Rick Trotter, and yours truly.