Category: Healthcare

All professionals in the medical industry should have their consumers’ best needs at heart, this includes insurance companies. Generally, they do, which is why so much importance is placed on the translation of the Summary of Benefits and Coverage (SBC) in the medical industry. 

The role of a SBC is to ensure that consumers are aware of the health benefits and coverage available to them through their healthcare plan. In fact, the Affordable Care Act (ACA) typically requires that any group of health plans or health insurance companies provide a summary of benefits and coverage that can accurately describe the benefits and coverage available under the plan. While that definition will give you a quick glimpse at why SBCs are so important, let’s dive a bit deeper into this complicated topic and how medical translation comes into play.

What is an SBC?

Alongside helping consumers understand their health plan’s features and offerings, an SBC also covers the costs associated with the plan. An SBC can cover very complicated topics, such as cost-sharing rules or limits and exceptions to coverage, in a way that is easy for the average consumer to understand. One way that a health insurance or plan company can do this is by providing consumers with a “Uniform Glossary” designed to clearly explain any medical or insurance-related terms that may apply to a plan. Not only are all plans required by the ACA to provide a SBC to their consumers, but they must follow a uniform template that is customized to reflect the terms of a specific plan. 

Why do SBCs matter? 

It is of the utmost importance that consumers have access to an SBC. Not only does this access help them understand their plan features and the costs associated with it once they’re enrolled, but they can use the SBC to answer some of their general questions regarding a health plan before they choose to enroll in it. This knowledge helps consumers make informed decisions about their health and finances. 

Why does an SBC need to be translated into other languages?

Because we live in an increasingly global world, health plans and insurance providers must keep diversity in mind. A minimum of 350 languages are spoken in homes throughout the United States. While providing SBCs in each of those languages wouldn’t be possible or even necessary as many of these languages are spoken by bilingual citizens, compliance regulations dictate which languages providers must accommodate. Vital plan information must be available in the 15 non-English languages most commonly spoken in a state or languages spoken by at least 10 percent of a county’s population. The ACA, and other related statutes and regulations, currently have strict language requirements. For example, qualified health plan insurers that have been registered for at least one year are required to provide oral and written translation services to consumers in a minimum of 150 languages.

It is important to remember that the translation of the Summary of Benefits and Coverage is not just a matter of compliance, but of inclusion. Providing resources for a growing and diverse population should always be a priority.

If an apple a day keeps the doctor away, can it also keep the medical insurance claims away? Nobody enjoys paperwork, but medical insurance claims are a vital part of the healthcare system. If patients don’t want to pay out of pocket, and medical providers want to receive swift payment, it’s important that everyone works together to properly file these forms. There is one major roadblock insurance companies can encounter. This process can be disrupted without the proper translation of medical insurance claims. 

What is a medical insurance claim form? 

Medical insurance claim forms are necessary when a patient needs to request reimbursement or direct payment for any medical services they’ve obtained. Basically, they are of the utmost importance for making sure medical service providers get paid. In order for these payments to come from insurance companies, either the patient or the provider must submit the proper medical insurance claims. There are two options for submitting a medical insurance claim. The first option is generally the most convenient. The medical services provider will directly submit the claim for the patient to the insurance company electronically. Another option is for patients to personally fill out a health insurance claim form and send in the paperwork. Most insurance companies offer electronic forms that patients can download and submit online. This process more commonly occurs if the health service provider is not in a patient’s health insurance network and therefore can’t file a claim on their behalf. 

What information does it contain?

The importance of the translation of medical insurance claims

The stakes are high when it comes to the translation of medical insurance claims. If a claim form is not in the native language of the claimant, there is always the possibility of misrepresentation on the insured’s part. Or, potentially, the misunderstanding on the insurance company’s part. Claim forms can be considered critical documents for health coverage access. Not providing translated claim forms in different languages can limit the ability of LEP speakers to properly complete their forms for claim processing. Mistakes can be made and misunderstandings can occur. Once the claim is filled out by the LEP speaker, the insurance company could require translation services to process it properly.

Insurance companies must comply with regulations regarding insurance forms, as many are considered to be critical documents. Critical documents that help obtain health insurance coverage or access to health care services can be required by state or federal law to be provided to the following people: qualified individuals, applicants, qualified employers, qualified employees, or enrollees. In most states, the top 15 languages spoken by the LEP populations of that state must be translated. 

Generally, it’s vital that insurance companies act in good faith at all times in regard to the insurance policies they write. Insurance policies are contracts. Insurance companies must do their best to uphold these contracts, including providing the necessary translation of medical insurance claims to guarantee patients’ access to healthcare coverage.

Every member of the medical profession should first and foremost prioritize patient safety. One such way to be successful at protecting patient safety is to dedicate resources to the proper translation of “instructions for use” (IFU). Essentially, the term IFU refers to the patient labeling found on many prescription medicines and medical devices. The manufacturer of the drug develops the patient label. But the FDA (a United States government agency) is in charge of approving it. IFUs are especially important when a medication has complicated dosing instructions and the patient may need help using the product properly.

As we live in an increasingly global world, medical device manufacturers and pharmaceutical companies will require assistance translating IFUs into other languages. Quality translation improves patient safety and helps get medical devices and medications approved for distribution throughout various regions. 

Why IFUs Matter

From a consumer standpoint, IFUs are of the utmost importance. The information included in an IFU helps provide the proper use of a medication or device, as well as any necessary precautions. The FDA requires that medication guides, such as IFUs, come with certain medical products. Usually, they do so when they’ve determined that: 

• The consumer requires specific information to prevent serious adverse effects.
• A patient has the right to be aware of serious side effects before deciding to use this product.
• Proper usage of the product is essential to its effectiveness.

Medication guides, including IFUs, must be given to consumers each time the medication is dispensed. It is worth noting that not all medications will provide an IFU. If a consumer ever has questions about a medication, it is best that they consult a healthcare provider or pharmacist. 

Where Translation Helps

Now, looking from a business standpoint, European regulations can provide an example of the importance of translating IFUs. The translation of an IFU is necessary for sale in Europe. Medical products in Europe must have a CE Mark. This mark guarantees that the safety and authenticity of a product are verified and translated properly. 

A CE Mark allows a manufacturer to sell a product throughout the EU. In order to obtain that mark, all materials (such as an IFU) are translated into each of the 24 official languages of the European Union. In Europe in particular, all products must have a CE Mark, which enables manufacturers and traders to commercialize them in the European Economic Area (EEA). 

The Future of IFUs

The standards for medical professionals and products evolve and adapt over time. The digital age is, of course, affecting patient safety regulations. Those who wish to market their products in the European Union should prepare for the emergence of the eIFU (electronic information for use) in 2020. The new eIFU requirements aim to increase medical device safety and effectiveness by providing users with the most current information. An eIFU can include video and audio files, which will make it easier to demonstrate how to operate and handle medical devices. eIFUs will allow companies to bring revisions or changes to the market faster. This extra content will require translation services to ensure all consumers can understand a video or audio file. 

New regulations will be in place in 2020 that medical device manufacturers in the European Union need to prepare for. Manufacturers should be prepping for the change now, including getting ahead on any translation needs.