Managing Language Barriers Like a Boss

I love being the mom of a teenager. It offers such insights into the things I don’t know or understand. Like language barriers, for instance. My darling daughter was sharing a story with me recently about someone she’s not very fond of. “Bruh, he’s just chud.” “I’m sorry, chud?” I responded. “Chud,” she said. “Facts, mom. He’s just ugly.” I wasn’t sure if she was referring to his appearance or his aura, so she thoughtfully clarified it could be applied to both. Being a child of the 70s and 80s, I’m fully aware of speaking with such confusing and altered language. “Grody.” “Chill.” “Gag me with a spoon.” “WHATever!” She doesn’t have much on me with that. However, her sarcasm and wit are entirely more sophisticated. All of that to say, it just reinforces as time passes; some things never change. Facts, mom. Facts. Riiight – Right – Right. Bruh!

Ironically, that thought process leads me to health insurers and how interactions with physician practices have evolved over the years – or haven’t. Confusing and altered language seems to be the norm when interacting with payers. We’ve become accustomed to terminology without truly understanding the meaning: clinical vs. administrative; coding vs. narrative. These language barriers contribute to delays, denied claims, physician burnout, and potentially compromised patient care.

For entirely too many years, we’ve allowed these barriers to weave themselves into the complexity of healthcare, to the point we struggle with meaningful conversations. Thus, they play a significant role in shaping many of the legal disputes in today’s healthcare.

For example, a RICO (racketeering) lawsuit has been filed against Express Scripts and its parent company, Cigna, accusing the PBM of using a Swiss entity, Ascent, to siphon money from drug manufacturers instead of passing rebates on to clients. Another example, Aetna agreed to pay $117.7 million to resolve False Claims Act allegations it submitted or failed to correct inaccurate diagnosis codes for Medicare Advantage patients, allegedly inflating payments received from the federal government.

And yet another example, UnitedHealthcare is also facing a lawsuit and investigations over inflated Medicare Advantage payments by manipulating patient diagnoses to make them appear sicker, triggering higher reimbursements.

These cases are not just about dollars or compliance – they reflect deeper, systemic misalignment in how care is communicated, interpreted, and justified. Until we address the fundamental language divide between physicians and insurers, we will continue to see these conflicts escalate beyond administrative friction into legal battles that ultimately affect the entire healthcare system.

Did I mention I’ve been in this industry for 30 years, now back at NCMS doing the exact same thing I did 25 years ago? Facts. Riiight – Right – Right. Bruh!