Lost in translation

Benefit managers bemoan the scarcity of useful data, though they may have reams of reports from their plan. The real answer lies in the words you use. Imagine a benefit manager faced with this question: How much did we spend last year on depression?

The phrase "how much did we spend?" could mean how much the plan actually paid in benefits (after copays or benefits from other plans), or how much the plan benefit or allowed amount was. It could include or exclude how much the employee paid in copays and deductibles. "Last year" could mean calendar year, plan year or fiscal year. It could mean the most recent 12 months. Furthermore, it leaves vague whether the manager wants only the dollars that left the plan during the "year" (incurred and paid claims) or the dollars that were spent to cover all the services that occurred during the "year," regardless of when the claim was actually paid (incurred).