Like A Good Neighbor?



Hope everyone had a great weekend! The only thing hotter than the Southwest United States right now is the movie theaters, thanks to Barbie (hot cast) and Oppenheimer (hot bombs). Both are smashing expectations.
I was able to catch Oppenheimer and thought it was pretty good, and it might just be the movie that gets Christopher Nolan his first Oscar.

In Case You Forgot

Now for those of you who read this religiously, you may be wondering what happened to the finger that I broke a few months back (probably not but appease me).

Did I have surgery? Did they amputate? Am I in a cast for life?
The correct answer is…nothing. We decided to do nothing.
And during the several appointments it took to reach this conclusion, I was exposed to the haunts and horrors of the US healthcare system, in particular insurance, that many of you have already experienced.

Here’s What Happened

At my first appointment in Urgent Care the PA took an X-ray to determine that my finger was, in fact, broken, wrapped it up, and referred me to a hand surgeon because “I would likely need pins put in place”.
The bill for this trip was $391.81. Maybe $100 of which was for the X-ray, and the other 250ish for the ~invaluable~ advice.
At the hand surgeon they decided it’d be good to take another X-ray, told me that I shouldn’t have had my finger wrapped, and said that surgery wasn’t the best option and that the “swelling should go down in the next 1-2 years.”
The bill for this trip was $193.01. $70 of which was for the additional X-ray and the other $120  for the ~invaluable~ advice.
So now I sit here, $584.82 poorer, with no treatment to my pinky, and the typing speed of a rhesus monkey. But hey, I did get some very ~invaluable advice~.

This Must Have Happened To Someone Else Too

Obviously, when you spend that much money to be told you should do nothing you become frustrated, as I did.
The way health insurance typically works is that your plan has a deductible, mine is $1,500, and until you reach that deductible in eligible medical expenses you will have to pay out of pocket for most care you receive, with few exceptions. This is the scenario that I found myself in.
I found myself thinking “Well that’s stupid, as a young and active 25-year-old, I don’t see many situations where I would incur that amount, unless something serious were to happen”. Translation: young, healthy people will hardly hit their deductible, and will pay for a higher percent of visits out of pocket. Most people who hit their deductible deal with chronic illnesses, have a family/dependents, or experience a big accident.
This was an ah-ha moment for me.

What if there was an additional insurance plan that would cover up me up to my deductible ($1,500 for me), so that I wouldn’t ever have to pay for healthcare? I thought I was a genius.
Come to find out it exists. And it’s called an HSA account lol, which I have.
Most companies will include an HSA account in their coverage as a way to offset unexpected medical bills, contribute towards your deductible, and invest for future health insurance once you retire. It’s like other insurance and 401ks, where money can be pulled from each paycheck and added to this account tax-free.
I was just doing it wrong. Instead of ensuring I made enough contributions to cover my deductible, I was using my account to pay for toothpaste, sunscreen, and sunglasses (yes, those are all valid purchases with HSA providers).
So, really this was my fault, and my first idea was debunked. But then I had another idea.


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The Real Problem And Real Solution

One of the main downfalls of the healthcare system are the antiquated incentives. Most of the money practices make comes from billable services, AKA things they can do and bill insurance for. Therefore, professionals are looking for nuanced ways to make more money, while the patient is hoping for the smallest bill possible.
As crude of a comparison this may be, it’s like when you get the oil changed on your car and the dealership says you need new tires, new filters, new windshield wipers, and asks if you’d like to replace them. To which your father-figure has warned you to “say no to everything”. They take advantage of the knowledge gap of their customers and try to sell you on more products because you don’t really know that much about cars.
In healthcare settings the same thing happens, except they usually won’t ask for permission and most patients won’t question things because “I’m not a doctor, they are, and they probably know best”. Again, this knowledge gap between patients and providers is where billable services can be added per the doctors discretion.
The current healthcare system incentivizes doctors to see as many patients as possible and find things they can bill insurance for, which ultimately comes as a detriment to the patient. This system is used across the board; doctors, dentists, veterinarians, chiropractors, nursing homes, you name it.
In the personal visits I described earlier; I pretty much had the same appointment twice. I went in, took an x-ray, and given information on what to do. Did they really need to take another X-ray? Probably not, but it was something they could tack on.
So, what’s a better way forward?
Obviously, this is a whole can of worms that many people have tried to address, but there is one thought I had that could help.
There should be a service that audits and negotiates every medical bill you get. Let’s face it, the people billing you are human too, they get tired around 4 o’clock and want to go home. They can make mistakes.
This service would be trained to specifically look for mistakes, places where they may be trying to pull a fast one, and warn you on services that you do and don’t need before you go into your next appointment. In my case, a simple “Hey Matt, you don’t need another X-ray, they have your previous one on file” would’ve been perfect.
You are not an expert in billing, cost of services, and understanding what’s necessary vs. what’s not, but this service can be.
How would it make money? Easy, monetization could happen in two different ways:
  • This service could take a percent of every dollar they saved the customer on their final bill.
  • Charge a small amount annually.
You would definitely need some experts on your side to get this started and the barrier to entry could be huge given how much say insurance companies have on the regulatory landscape, but I think this idea has the potential to be big and provides insight into how I try to find ideas from my life’s frustrations.
‘Til Friday.

from, matt

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