Path: bloom-picayune.mit.edu!snorkelwacker.mit.edu!americast.com!americast.com!americast-post Newsgroups: americast.twt.metro From: americast-post@AmeriCast.Com Organization: American Cybercasting Approved: americast-post@AmeriCast.com Subject: Pains of health insurance forms give new business plenty to Date: Mon, 2 Nov 92 15:45:13 EST Message-ID: \SE B;METROPOLITAN;MONEY;THE ENTREPRENEURS \HD Pains of health insurance forms give new business plenty to bear \BY Karen Riley \CR THE WASHINGTON TIMES Spend any time in the hospital and you're inevitably greeted with a pile of medical bills and insurance forms that must surely have been written in some form of Sanskrit. Just as baffling are those charges by a doctor you can't remember for services you're not sure you actually received. That's where Shirlee Stearn of Rockville comes in. Last fall she launched ProClaim to relieve the sick and the elderly of the headache of so much baffling paperwork. Clients pay an annual fee of $300, which covers 50 insurance claims. In exchange, ProClaim organizes all the paperwork - "sometimes two shopping bags full," she said - processes the forms, then tracks each claim to make sure it's paid. If the insurance company refuses to pay the bill, ProClaim will dispute the ruling - and often wins. "Just like you need an accountant to do your income taxes, if someone is in the hospital . . . you need someone like us," she said. Mrs. Stearn learned the vagaries of insurance claims during 15 years filling out forms in doctor's offices. But eventually she wanted to work for herself and knew she had a marketable service. Friends and patients had been enlisting her help to process their forms for years. Before launching the company, Mrs. Stearn attended several classes offered by the Small Business Administration "to get a background in business." Included in the course was the advice to register her company's name as soon as possible. She did. Prior to the startup, Mrs. Stearn had seen an advertisement for a service in Virginia that was exactly like what she wanted to do. She called up the owner and had a long, surprisingly cordial telephone conversation. The contact paid off. Three months later, the competitor phoned back and asked her to take over his client list because he was leaving to help with a family business. "It was a wonderful beginning," she said. At first, the windfall meant a lot of work for no compensation because the clients were on a prepaid annual contract. Nevertheless, she had an immediate client base and the opportunity to build up loads of good will. Ultimately, most of her new clients opted to renew their contracts. "It seemed to be worth it in the end," she says now. To attract additional clients, she placed ads in a variety of local publications, advertising frequently over a six-month period "until I figured what was working for me." One ad asked, "Do you feel that you're chained to your paperwork?" Business has been more than ample to keep both Mrs. Stearn and a part-time assistant occupied. "I'm inundated," she said. In recent cases, Mrs. Stearn prodded an insurance company into paying a second month of nursing home care, saving her client $4,000, and persuaded Massachusetts Medicare to pay the medical bills of an elderly lady who had a stroke while visiting that state. The woman's husband had tried unsuccessfully to communicate with the state's health office for four months. "I get a lot of satisfaction in doing this," Mrs. Stearn said. Currently, ProClaim is trying to get an insurance company to pay the medical costs of a woman who suffered an embolism after undergoing knee surgery for arthritis. The insurance policy excludes this type of surgery, but Mrs. Stearn argues the insurer should cover the $16,000 in medical bills connected to the embolism. Rena Greer of Bethesda signed up with ProClaim to tackle the medical bills of her 89-year-old mother, who lives in Brooklyn, N.Y. "We just turn over everything to Shirlee. She's very detailed," Mrs. Greer said. "It just takes all the headaches away." ProClaim isn't the only service available for elderly with health-insurance problems. Both the American Association of Retired Persons and local governments' offices for the aging offer counseling services. "What I do is much more complicated than what they do," said Mrs. Stearn. "I track the claims as well as file them. There are a lot of claims that are denied in error. They need a lot of following up." John Linkous, executive director of the D.C.-based National Association of Area Agencies on Aging, which represents the nation's local government senior aid offices, agrees companies such as ProClaim play an important role. "Public services, in many areas, are not enough," he said. In the future, insurance processing services may be needed less if the insurance industry achieves its goal to standardize forms and move to full electronic claims processing within four years. Such reform would eliminate many paperwork problems caused by a health care system that currently uses more than 400 computer formats. Even if that goal is achieved, however, people with more than one insurer still will have trouble coordinating their coverage, said Don White, spokesman for the Health Insurance Association of America in Washington. Also, uniform forms don't guarantee insurers will pay, industry experts note. Mrs. Stearn says she believes her business could grow much larger given the level of demand she's identified in the Washington area alone. But at 61, she has no major expansion plans. "I want to know my clients as individuals," she said. This article is copyright 1992 The Washington Times. 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