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What Happens When a Healthcare Startup Leaves You With the Bill

122 points by osiris679 12y ago

minimaxir 12y ago
This is actually a Valleywag article, which is a banned domain on HN so the original link is using a workaround to show the article. (http://valleywag.gawker.com/what-happens-when-a-healthcare-startup-leaves-you-with-1598186714 http://valleywag.gawker.com/what-happens-when-a-healthcare-s...) In this case, the article is actually pretty good.
- michaelochurch 12y ago
  Valleywag shouldn't be banned. It can be a bit gleeful about the Valley's moral meltdown, but it's the only outfit in "the tech press" that tells the truth. Everything else is payola.
  - minimaxir 12y ago
    I agree that Valleywag shouldn't be banned on the basis that they often contribute unique articles not discussed by other tech outlets. (e.g. http://valleywag.gawker.com/the-laundry-quarters-startup-is-dead-1596481798 http://valleywag.gawker.com/the-laundry-quarters-startup-is-...) Although to be fair, there are a few "rich people in tech suck because they're rich" articles which are more hostile.
    - michaelochurch 12y ago
      Although to be fair, there are a few "rich people in tech suck because they're rich" articles which are more hostile. Not because they're rich, but because they've departed so far from the founding values of technology. Picking on the average "Google bus" rider is mean-spirited and pointless, but the "leaders" of private-sector technology really are rapacious assholes. This sector of the economy really is run by horrible human beings and pointing out is not mindless hostility, but confronting one of the most important issues that our generation faces.
      - jrochkind1 12y ago
        I'm curious what you think "the founding values of technology" are, and when they were established (the founding of "technology"? Like the wheel? Or just transistor-based technology?), and by whom/what.
        michaelochurch 12y ago
        I'm curious what you think "the founding values of technology" are I'm talking about the pay-it-forward culture of the 1950-70s Valley when it was cheap to live there and people did everything they could to help each other out. This was the era when Hewlett-Packard refused to do a layoff: instead, it cut costs with a 10% pay cut and a day off work every other week. There was a time when software had an R&D culture, and Northern California was full of people trying to do something new and interesting. Now, startups are a safety career for failed McKinseys and Goldmanites, whose VC friends put them into executive positions and let them boss nerds around, but it wasn't always that way. You didn't go in thinking you'd be a billionaire, but you could get what would now be an upper-middle-class lifestyle and work in the sort of R&D environment that doesn't exist anymore, because the slimeballs killed it.
    - matdes 12y ago
      And the moderators of HN can still choose to use their discretion to remove certain articles, without necessarily banning an entire news outlet.
  - robg 12y ago
    That's a bit cynical, no? Everything else is payola? Who knows why certain publications are banned. Maybe it's not their content but that they spammed the site and with sockpuppets? That said, I'd like to fewer filters on which publications are banned. I submitted something from CNET that went to auto-dead. Seems like something I'm sure Dan and team are on top of. Why not send them note?
  - korzun 12y ago
    Most of ValleyWag articles are extremely biased and twisted. There are actually too many things to list, their Uber coverage, their coverage of start-up 'parties' and how people are throwing money there (while Gawker holds the same parties) etc. Then you have this: https://www.youtube.com/watch?v=_jtmFlUg56w https://www.youtube.com/watch?v=_jtmFlUg56w
bbarn 12y ago
I find the phrase "Don't A/B test with people's lives" to be in search of something catchy, or a zinger. The reality of big insurance has always been to be paid more than they pay out. Simple. You've always been a number to an insurance company.
- ISL 12y ago
  If insurers didn't make money, they wouldn't coordinate insurance plans. They're middlemen, like so many HN readers aspire to be, because there are efficiencies to be found in the middle. Insurance is a way of crowd-funding risk, though we rarely talk about it in those terms.
- xienze 12y ago
  > The reality of big insurance has always been to be paid more than they pay out. Well yes, that's how a company stays solvent... The problem with health insurance is that it's been perverted into a discount club rather than being insurance for catastrophic occurrences. It divorces consumers from the true cost of services and hence service providers are free to play with the costs all they want. Hell, you can't even really get an upfront estimate for a procedure... Car insurance covers accidents, theft, etc. That's it. Can you imagine how much e.g., an oil change would cost if it were commonplace to use car insurance for such routine maintenance? That's what really went wrong with health insurance in the US, and we're too far down that road to fix it.
  - bbarn 12y ago
    I've always viewed it as an arms race to see who can get away with what between providers, insurers, and patients (and before ACA, employers to a degree). The true cost of service at this point includes having staff and systems (with their own support staff) to negotiate and calculate the cost on both the insurer and the provider side. So, in a way, if you have one particularly tough to deal with insurer, that cost gets distributed among all patients, and their insurers as well. In addition, the basic cost of any visit now includes some of that administrative overhead. In the oil change analogy, if you had to walk into the shop, and there was a base price of $50 to cover the administrative costs, you had to wait until you saw a mechanic to decide if you really needed an oil change, and they charged $50, and then you paid the $20 dollars for the oil change, you can bet by now someone would have started marketing a per-visit copay style insurance for cars too. None of this is to say I disagree with you, just that it's even worse than I think we all think it is.
tkinom 12y ago
It happened to me ~10 years ago with another health care startup. The sign up booklet looks good and we switch to it. I was with a big company ( - Nokia )at that time. But when the time comes to pay hospital/doctor bill, it has all kind of reasons not too. I documented the phone calls with them, put the detail on a yahoo group and make sure the group was opened to everyone who want to join and also invited their company's PR/Marketing to join that group. The issue was resolved immediately. I don't think that company is alive today. Healthcare insurance start up is not easy. I don't trust them base on that experience. The main issue with insurance is always how much you can trust them when they need to pay up. In the short term, they can always promise low rate to get your attention. But that only get the young folks to switch. After one been thru the experience I been thru, it is hard to trust that kind of company again. In today's internet age, it is impossible for any "startup insurance" company to do that kind of "hack" to try keep their cash flow and not immediately to have their reputation out to everyone in the world.
will_brown 12y ago
I have posted it before, but any time a healthcare thread pops up I like to mention a project I co-founded (before Obamacare/Affordable Healthcare Act). Primary care coverage for $20/month $10 copay for ARNP/PA visits and $25 copay for Doctor visit. Even if someone is covered on the exchange this type of primary care plan can be far more cost effective than paying the copays under many of the plans. See: http://pfccmember.com/Membership_Plans.html http://pfccmember.com/Membership_Plans.html >So I went to my new Oscar-approved doctor, who recommended routine blood work...On April 28th 2014, I received a first bill from the hospital detailing how Oscar covered none of the in-hospital labs and I would need to pay $1640. A second round of labs before April 28th pushed the total bill to over $2000. Even our little start-up was able to negotiate $99 for blood work labs, which is out of pocket to the patient. If the same patient uses insurance that rate skyrockets, usually requiring patients to pay out of pocket anyway because of giant deductibles.
- alyandon 12y ago
  It is absolutely ridiculous how pricing schemes like that are even legal. Have insurance that covers a non-typical lab test? They bill $1000 to your carrier (regardless of what th e contracted rate will be) and you are usually responsible for a fraction of that because of deductibles. Don't have insurance and are a cash-only customer? They bill you $150. Have insurance and insurance declines to pay? You get billed $1000. A real example of this, my son had a routine vaccination performed at a Baylor clinic and my insurance company drug their feet on remitting payment to them. So, Baylor turned around and invoiced me for $1250 and was ready to send that to collections. Turns out that the agreed rate with my insurance carrier for that vaccination was well under $100.
  - maxsilver 12y ago
    It gets even worse than that. Some people are stuck with an HSA. A HSA is not insurance (it covers nothing), but it looks like insurance (so hospitals still charge you the 'ten times more' price). A $100 doctor visit, becomes $900 "charged" to your HSA (because you 'have insurance' so they can eat the artificially-inflated cost). But since HSA never covers anything, the insurance always just passes that $900 bill on to you. They stamp "THIS IS NOT A BILL" on the top, but that's a lie, it always requires you to pay money. You call up the hospital and explain "I don't have insurance, I need the sane price." They say "we can't give you that price, you have insurance." No one in healthcare understands that HSA's aren't insurance, and cover nothing, so no one will let you pay a manageable sum of money.
HarryHirsch 12y ago
With bogus physician bills my SOP is to call the office and tell them that I will let the bill run to collection and dispute it in court. This strategy never failed, physicians are mortally afraid of having to admit that their billing practice is questionable. With refunds from the insurance company I have found that a nice letter "please pay up 10 days from now or I will get a title in court" works wonders. I never had to no, not once.
- korzun 12y ago
  A mature way to handle this is to ask for a copy of the bill for clients that are paying directly, without insurance. Please don't take me to court now.
- lilsunnybee 12y ago
  More likely, doctors are very averse to lawsuits, and would sooner provide care to one patient at a loss than defend against a lawsuit, especially when it doesn't seem like a bluff because you seem like someone who could afford it (not typical btw).
shepardrtc 12y ago
This seems similar to third-party warranty companies. They offer full coverage for low amounts, but when the time comes for them to pay up, they're impossible to deal with. Can't reach them on the phone, they need things to be faxed(!) over, and then because of so-and-so reason, it won't be covered. Healthcare shouldn't be handled by startups. Its too expensive and there's too much riding on it for something that could go belly-up at any moment to handle. Of course, that brings up the question: How do you actually start an insurance company? I'd imagine that in a perfect world, the government could guarantee your coverage until you get enough in your coffers to handle things without a backup.
- sp332 12y ago
  Can you buy a good after-market warranty? I mean the dealers must be getting their first-party warranties from somewhere.
  - shepardrtc 12y ago
    Perhaps, but I've never seen one. Though I suppose getting an extended warranty from the manufacturer is in the same vein. And dealers work more naturally with the manufacturer so there's usually less headache.
- flatline 12y ago
  I've talked to a couple health-care startups on the East Coast that have started by tackling one small aspect of healthcare and built off of that. Prescription drug tracking. OR procedures and checklists. There are tons of companies in the medical startup space that are doing good work, there are tons of areas that traditional big tech companies have failed to innovate in that are ripe for being upset. Playing fast and loose with insurance claims sounds more like outright fraud.
  - commandar 12y ago
    >I've talked to a couple health-care startups on the East Coast that have started by tackling one small aspect of healthcare and built off of that. Prescription drug tracking. OR procedures and checklists. There are tons of companies in the medical startup space that are doing good work, there are tons of areas that traditional big tech companies have failed to innovate in that are ripe for being upset. While this is true, one of the problems currently being faced by the industry right now is that all of these niche vendors have their own ideas about how data should be handled, and it's resulted in a fair amount of balkanization of the healthcare IT industry. It's getting better, and HITECH and the ACA are finally pushing toward real standardization and data interchange, but from where I'm sitting (working in healthcare integration), it's probably going to take us another decade to sort out the mess things are in today.
eggbrain 12y ago
I had a conversation with a friend recently who was a doctor. He was telling me that he had 3 patients in a fairly short period of time that had come in with mysterious symptoms (they were all in their 70's) and that had died soon after being admitted. While he knew that he had technically done everything by the book to treat them, he worried that he had made a mistake along the way that possibly could have been the cause of their death. It made me appreciate that the code that I produce as a web developer most of the time would never have me facing those same ethical dilemmas -- there are very few times a bug in a web app would cause people to die or to be financially ruined. In this case, however, you can see what happens when an ambitious startup ends up trying to apply things web developers had done for years (A/B testing, "design" decisions) to avenues of life where people's livelihood or health is at stake -- people can end up getting hurt. "Failing hard and fast", the motto many people have regarding startups, cannot be taken with the same arrogance. If you want to change the world in ways that impact people on a personal level, be ready to be very careful with the trust your customers put in you.
- famousactress 12y ago
  Absolutely. I've been in healthcare for a bunch of years (I dunno, sheesh, I guess like 14?). For a big stint of that I built systems that aim to prevent medication errors in hospitals by telling clinicians when doses were due, etc. I know of at least two incidents where code that I wrote failed in a way that (due to some edge-case concurrency in one case, and daylight savings time in another case) didn't make it clear to a nurse that another nurse had given a medication to a patient and the patient received a double-dosage of a pretty severe drug. Imagine getting that call. It's every bit as fucking terrible and humbling as you'd think. Far more numerous (thankfully) were the calls that we got reporting that we stopped double dosages or even order-of-magnitude label misreadings on drugs. I know of more than a handful of instances that code I wrote may have literally saved a life. I've been lucky to have found myself at companies that take this stuff really, really seriously. It's a really hard balance to strike when failure is as devastating as it can be in healthcare, but the status quo is pretty terrifying also. In general every health IT shop's culture finds some balance between making decisions based on fear, and trying to achieve a velocity that allows problems to be fixed quickly and the greatest positive impact possible against the problem they're solving. I talk to a lot of people who want to work on "big/real problems" and list "healthcare" as one of them but when it comes down to it are often pretty freaked out about the stakes. It's weird to be used to the gravity of it, I certainly am now. I can't even wrap my head around what it would mean to work on something that doesn't hurt people when it fails.
r0m4n0 12y ago
With a healthcare startup, you will almost always pay more. Large insurance companies are able to bargain the best rates through many means based upon their size. Even when the provider disagrees (with capitated services for example) and bills the member, the larger insurance companies will reimburse the member and then bill the provider.
rlvesco7 12y ago
I'm sorry but I've had all these problems and many more with traditional health care companies. As a diabetic I'm intimately familiar with the health care system. It's a hard space to work in and I'm happy to see startups trying to tackle it. But it won't solved soon. Unlike Dropbox, where they "solved" sync more or less there is no one thing in health care, but many.
GotAnyMegadeth 12y ago
Sorry for over repeating what people always say, but I am genuinely so grateful for the UK's NHS.
- arethuza 12y ago
  I get private healthcare in the UK through my job - the only time we have used it was when my teenage son got his tonsils out. What was amusing was that at one point the anaesthetist came up and said there had been a mistake in the billing and I'd have to pay part of the bill directly. Having heard all the horror stories from the US I was thinking it was going to be a huge amount of money - he very apologetically gave me a bill for £12.00 (yes, twelve pounds) :-) [NB Worth noting that although we do have private health care, anything serious that has happened to us over the last few years was fixed by the NHS].
  - lilsunnybee 12y ago
    You smug bastard. Joking, but i'm in the US and have had so many issues in my life with huge medical bills and debt collectors, denial of care, insurance refusing to pay because a doctor messed up the paperwork, insurance not covering certain medications, or saying the dosage needed to be changed, that i'm almost not. :-p
    - arethuza 12y ago
      Well, as anyone will tell you who lives in the UK, the NHS isn't perfect, but I personally happen to think that the model we have of a pretty good health care system for everyone and private health care for the tiny minority who want it seems to work fairly well. Mind you the NHS is socialism... but perhaps telling that the founder of the NHS, Aneurin Bevan, called his book on the subject In Place of Fear - which sums it up really. http://en.wikipedia.org/wiki/Aneurin_Bevan http://en.wikipedia.org/wiki/Aneurin_Bevan NB I find illnesses and injuries in a family stressful enough to deal with as it is - adding bureaucracy and financial stresses would be a nightmare.
joshfraser 12y ago
The problem with insurance companies is that they are fundamentally conflicted. As for-profit businesses they have a fiduciary responsibility to maximize profits. Unfortunately the only way to maximize profits is to decline coverage. The problem with Obamacare is that it does nothing to fix this problem. Who wants to be the guy responsible for that many lost jobs?? So, instead they propped up the insurance companies and made everything more complicated for everyone. The only solutions I see are to have non-profit insurance companies or a single payer system.
- sova 12y ago
  well said! what do you mean by single payer system?
  - joshfraser 12y ago
    Single-payer health care is a system in which the government, rather than private insurers, pays for all health care costs. http://en.wikipedia.org/wiki/Single-payer_health_care http://en.wikipedia.org/wiki/Single-payer_health_care
- ceejayoz 12y ago
  Many of the insurance companies are non-profits, but that doesn't help much. http://seattletimes.com/html/localnews/2017460805_surplus09m.html http://seattletimes.com/html/localnews/2017460805_surplus09m...
- r0m4n0 12y ago
  https://www.blueshieldca.com/bsca/about-blue-shield/health-reform/our-involvement/healthcare-quality-value/our-pledge.sp https://www.blueshieldca.com/bsca/about-blue-shield/health-r... One of california's largest health insurance companies is a not for profit and doesn't stockpile money. why is healthcare still expensive?
  - ceejayoz 12y ago
    Remember that that pledge can be fulfilled by increasing employee (i.e. CEO) salaries, nicer buildings for the company, etc. That's what's happened at our local BCBS affiliate.
kjjw 12y ago
"So I went to my new Oscar-approved doctor, who recommended routine blood work. The hospital called up Oscar and Oscar's operations department assured both the in-hospital labs and administrators that this blood work would be covered by my plan so we went ahead with it." Urgh American health care is just so weird. It makes my skin crawl.
- cryoshon 12y ago
  If by weird you mean terrible and dehumanizing, you're entirely right. It's designed to rape the most money away from sick people while providing them just enough care to keep them alive and needing more care, and thus spending more money. It's also designed to be extremely expensive even for those who are healthy by artificially inflating the costs of routine stay-well procedures and testing on top of the ridiculous monthly fees. And you can forget preventative medicine or any cutting edge treatments unless you're flush with cash.
  - Shivetya 12y ago
    the design is handed down by government mostly, because of the bewildering number of laws, regulations, and such, that have wrecked havoc in health care for years. Then to top off whatever mess the Federal government makes each state just has to be enough different that what you bought in one state might not be exactly the same in other; used to be (and might still be) that you could not shop across state lines because of government. Then once you pass that insurance hurdle that regulation/regulators/insurance companies put up its off to the races with the doctors and facilities who may both not be covered by policies again because of the weird way regulations and such work. What can and cannot be performed by who and where it can and cannot be performed. The the kicker, using low payouts of medicare and such because the government knows the insurance companies and hospitals will make it up on people who can pay thereby redirecting the ire
- jjoonathan 12y ago
  It's evil, inconvenient, and (amazingly) it's even less efficient that its government-run counterparts both inside and outside the US: http://healthcarereform.procon.org/view.resource.php?resourceID=004083 http://healthcarereform.procon.org/view.resource.php?resourc... What will it take to convince people of this? Our society already accepts that markets aren't a suitable medium for every human endeavor, how long must we continue to experiment with private (basic) health insurance before we add it to the list of exceptions? If our health sector ran as efficiently as everyone else's (as a fraction of GDP/capita), the money we currently pay for medicare and medicaid would suffice to provide universal coverage for every single person in the US. http://healthcarereform.procon.org/view.resource.php?resourceID=005522#III http://healthcarereform.procon.org/view.resource.php?resourc...
kenrikm 12y ago
This story seams par for the course when dealing with insurance companies regardless of if it's startup or not. I've had the same exact issue with everyone from "United" to "Humana" and more recently "HealthNet" You will be told something is in network and it's not, a lab location is listed on their website as in network and then they claim it's not covered later. Sadly, this seems to be an area where legislation needs to bring out the big stick and force them to cover services that they had listed as "in-network" bad data is no excuse.
- lilsunnybee 12y ago
  Wish more people knew this. A lot of professionals on here might personally have a stellar health insurance plan through their employer that covers almost anything no questions asked, but those same big insurers will administer cut-rate plans to the majority of plan-holders and deny payment at the drop of a hat, or pick and choose what necessary care / medications they will / won't pay, often after the fact, seemingly arbitrarily or if submitted paperwork isn't flawless. It's a pretty good racket really; provide quality, hassle-free coverage to the high income, professional class, or anyone else that might have any say or sway or influence in government, and then for the working class majority refuse to ever pay out more per person than you are payed. That way you can cost-save like crazy and make obscene profits, but no one that matters cares and based on their experience it just looks like belly-aching and blowing things out of proportion.
jnardiello 12y ago
From the Oscar front page: "Free doctor visits via phone". WTF is this? How can a doctor visit by phone? All this story is just a smell on how deeply broken the entire US health system is (together with all the healthcare-systems of 3rd world countries).
- k-mcgrady 12y ago
  I could see this being really useful. There are many times I have needed questions answered by the doctor (e.g. I've been diagnosed with x - can I still do y safely) and the only way is with an appointment which wastes both our time. I wish my local GP would set aside 1 hour per day to answers questions via email or phone. It would make things much more efficient.
  - fr0sty 12y ago
    The issue with that, is there's no good way for the doctor to get paid for doing it. Prior to 2009 there was no billing code for phone calls or email and currently the rules around what is a "billable" consultation are complex and the coverage by insurers is far from uniform. More info here: http://patients.about.com/od/followthemoney/f/Why-Doctors-Wont-Telephone-or-Email-Patients.htm http://patients.about.com/od/followthemoney/f/Why-Doctors-Wo...
    - k-mcgrady 12y ago
      I was thinking more about my own healthcare system where the government pays the doctor. So his salary would just stay the same. In the US or other systems like it I can see how that would be an issue.
      - walshemj 12y ago
        well use something like the UK model where dr's can have both a NHS contract plus private patients.
- lotharbot 12y ago
  This was part of the coverage I had with QLiance in Seattle. I could send an e-mail or call my doctor on the phone and get a prompt response. At one point we went from "noticed problem" to "discussed via e-mail" to "at the clinic being treated" in an hour. Other times, we'd notice a problem and solve it entirely via e-mail or phone, and save the clinic visit entirely.
jackgavigan 12y ago
There is, sometimes, a tendency on the part of young, ambitious entrepreneurs, to be overly optimistic and assume that they can gatecrash an industry they know nothing about, set up a slick website and disrupt the big, bloated, uncool incumbents. Sometimes that works out but I believe that a new entrants chances of success are a lot higher if they have somebody on board who is actually familiar with the industry sector they're trying to disrupt. None of Oscar's founders have worked in health insurance previously. They come from tech entrepreneur/VC, consulting and technology backgrounds. Edit: Here's a good example of where some industry expertise might have been useful: "..it was a design decision to limit the information presented to hospital's on what is covered in detail (like inhouse labs)." There's currently a big trend in design towards making things simple. But there's a difference between making stuff simple and dumbing it down. Sometimes, stuff looks complicated because it's complicated.
- brandnewlow 12y ago
  I think that's an overly generous assessment. Oscar's founders have invested incredible sums of money into the company and are very well connected. If they've not hired people who know the insurance industry, it's safe to assume it's because they chose not to. This is not a small scrappy startup. This is a company started by powerful people looking to get into an opening they saw.
- lsc 12y ago
  I have Kaiser. It's vastly simplified because the people paying for my care are the same people who are providing my care. They also seem to have a real "get you up and running so you can get back to work" kind of attitude, which meshes well with my own values. I mean, consider for a moment how much of a pain in the ass it is to get an insurance claim on your house or your car or whatever filled. Multiply that by the complexity of medicine, and... yeah. You can see how it would get complex fast. Maybe this is an area where horizontal integration is the order of the day?
  - chaostheory 12y ago
    Kaiser is great. The problem is with Kaiser is that it's not available nationwide. If I remember, it's only available in big metros.
dangerboysteve 12y ago
Why not link directly to the article than that slow feed site? http://valleywag.gawker.com/what-happens-when-a-healthcare-startup-leaves-you-with-1598186714 http://valleywag.gawker.com/what-happens-when-a-healthcare-s...
- atestu 12y ago
  Because valleywag is a banned domain on HN for some reason
greenyoda 12y ago
In the U.S., insurance is regulated by the states and each state has a regulatory agency where one can go with complaints about insurance companies. I find it surprising that the abused customer in this story didn't file a complaint with the government. That would have probably made the insurance company stand up and take notice much more than complaining about them on Twitter.
- lilsunnybee 12y ago
  I never knew this, and sincerely doubt most people do. But besides this rare start-up, if you're an established player like Blue Cross, does one or dozens or even hundreds of complaints even matter?
DatBear 12y ago
>In the emerging health and wellness markets, startups like Oscar intimately disrupt and destroy their customer's lives through incorrect datasets where an A/B testing mentality results in exorbitant fees, angry hospital administrators and patients with no recourse except to bankrupt themselves paying bills they didn't expect. This doesn't make sense to me. How is an A/B testing mentality at fault for this? It has nothing to do with the incorrect datasets... you don't A/B test your data structure... I hope. A/B tests are blamed later in the article too, not really sure why.

122 points by osiris679 12y ago

This is actually a Valleywag article, which is a banned domain on HN so the original link is using a workaround to show the article. (http://valleywag.gawker.com/what-happens-when-a-healthcare-startup-leaves-you-with-1598186714 http://valleywag.gawker.com/what-happens-when-a-healthcare-s...) In this case, the article is actually pretty good.

michaelochurch 12y ago
Valleywag shouldn't be banned. It can be a bit gleeful about the Valley's moral meltdown, but it's the only outfit in "the tech press" that tells the truth. Everything else is payola.
- minimaxir 12y ago
  I agree that Valleywag shouldn't be banned on the basis that they often contribute unique articles not discussed by other tech outlets. (e.g. http://valleywag.gawker.com/the-laundry-quarters-startup-is-dead-1596481798 http://valleywag.gawker.com/the-laundry-quarters-startup-is-...) Although to be fair, there are a few "rich people in tech suck because they're rich" articles which are more hostile.
  - michaelochurch 12y ago
    Although to be fair, there are a few "rich people in tech suck because they're rich" articles which are more hostile. Not because they're rich, but because they've departed so far from the founding values of technology. Picking on the average "Google bus" rider is mean-spirited and pointless, but the "leaders" of private-sector technology really are rapacious assholes. This sector of the economy really is run by horrible human beings and pointing out is not mindless hostility, but confronting one of the most important issues that our generation faces.
    - jrochkind1 12y ago
      I'm curious what you think "the founding values of technology" are, and when they were established (the founding of "technology"? Like the wheel? Or just transistor-based technology?), and by whom/what.
      - michaelochurch 12y ago
        I'm curious what you think "the founding values of technology" are I'm talking about the pay-it-forward culture of the 1950-70s Valley when it was cheap to live there and people did everything they could to help each other out. This was the era when Hewlett-Packard refused to do a layoff: instead, it cut costs with a 10% pay cut and a day off work every other week. There was a time when software had an R&D culture, and Northern California was full of people trying to do something new and interesting. Now, startups are a safety career for failed McKinseys and Goldmanites, whose VC friends put them into executive positions and let them boss nerds around, but it wasn't always that way. You didn't go in thinking you'd be a billionaire, but you could get what would now be an upper-middle-class lifestyle and work in the sort of R&D environment that doesn't exist anymore, because the slimeballs killed it.
  - matdes 12y ago
    And the moderators of HN can still choose to use their discretion to remove certain articles, without necessarily banning an entire news outlet.
- robg 12y ago
  That's a bit cynical, no? Everything else is payola? Who knows why certain publications are banned. Maybe it's not their content but that they spammed the site and with sockpuppets? That said, I'd like to fewer filters on which publications are banned. I submitted something from CNET that went to auto-dead. Seems like something I'm sure Dan and team are on top of. Why not send them note?
- korzun 12y ago
  Most of ValleyWag articles are extremely biased and twisted. There are actually too many things to list, their Uber coverage, their coverage of start-up 'parties' and how people are throwing money there (while Gawker holds the same parties) etc. Then you have this: https://www.youtube.com/watch?v=_jtmFlUg56w https://www.youtube.com/watch?v=_jtmFlUg56w

bbarn 12y ago

I find the phrase "Don't A/B test with people's lives" to be in search of something catchy, or a zinger. The reality of big insurance has always been to be paid more than they pay out. Simple. You've always been a number to an insurance company.

ISL 12y ago
If insurers didn't make money, they wouldn't coordinate insurance plans. They're middlemen, like so many HN readers aspire to be, because there are efficiencies to be found in the middle. Insurance is a way of crowd-funding risk, though we rarely talk about it in those terms.
xienze 12y ago
> The reality of big insurance has always been to be paid more than they pay out. Well yes, that's how a company stays solvent... The problem with health insurance is that it's been perverted into a discount club rather than being insurance for catastrophic occurrences. It divorces consumers from the true cost of services and hence service providers are free to play with the costs all they want. Hell, you can't even really get an upfront estimate for a procedure... Car insurance covers accidents, theft, etc. That's it. Can you imagine how much e.g., an oil change would cost if it were commonplace to use car insurance for such routine maintenance? That's what really went wrong with health insurance in the US, and we're too far down that road to fix it.
- bbarn 12y ago
  I've always viewed it as an arms race to see who can get away with what between providers, insurers, and patients (and before ACA, employers to a degree). The true cost of service at this point includes having staff and systems (with their own support staff) to negotiate and calculate the cost on both the insurer and the provider side. So, in a way, if you have one particularly tough to deal with insurer, that cost gets distributed among all patients, and their insurers as well. In addition, the basic cost of any visit now includes some of that administrative overhead. In the oil change analogy, if you had to walk into the shop, and there was a base price of $50 to cover the administrative costs, you had to wait until you saw a mechanic to decide if you really needed an oil change, and they charged $50, and then you paid the $20 dollars for the oil change, you can bet by now someone would have started marketing a per-visit copay style insurance for cars too. None of this is to say I disagree with you, just that it's even worse than I think we all think it is.

tkinom 12y ago

It happened to me ~10 years ago with another health care startup. The sign up booklet looks good and we switch to it. I was with a big company ( - Nokia )at that time. But when the time comes to pay hospital/doctor bill, it has all kind of reasons not too. I documented the phone calls with them, put the detail on a yahoo group and make sure the group was opened to everyone who want to join and also invited their company's PR/Marketing to join that group. The issue was resolved immediately. I don't think that company is alive today. Healthcare insurance start up is not easy. I don't trust them base on that experience. The main issue with insurance is always how much you can trust them when they need to pay up. In the short term, they can always promise low rate to get your attention. But that only get the young folks to switch. After one been thru the experience I been thru, it is hard to trust that kind of company again. In today's internet age, it is impossible for any "startup insurance" company to do that kind of "hack" to try keep their cash flow and not immediately to have their reputation out to everyone in the world.

will_brown 12y ago

I have posted it before, but any time a healthcare thread pops up I like to mention a project I co-founded (before Obamacare/Affordable Healthcare Act). Primary care coverage for $20/month $10 copay for ARNP/PA visits and $25 copay for Doctor visit. Even if someone is covered on the exchange this type of primary care plan can be far more cost effective than paying the copays under many of the plans. See: http://pfccmember.com/Membership_Plans.html http://pfccmember.com/Membership_Plans.html >So I went to my new Oscar-approved doctor, who recommended routine blood work...On April 28th 2014, I received a first bill from the hospital detailing how Oscar covered none of the in-hospital labs and I would need to pay $1640. A second round of labs before April 28th pushed the total bill to over $2000. Even our little start-up was able to negotiate $99 for blood work labs, which is out of pocket to the patient. If the same patient uses insurance that rate skyrockets, usually requiring patients to pay out of pocket anyway because of giant deductibles.

alyandon 12y ago
It is absolutely ridiculous how pricing schemes like that are even legal. Have insurance that covers a non-typical lab test? They bill $1000 to your carrier (regardless of what th e contracted rate will be) and you are usually responsible for a fraction of that because of deductibles. Don't have insurance and are a cash-only customer? They bill you $150. Have insurance and insurance declines to pay? You get billed $1000. A real example of this, my son had a routine vaccination performed at a Baylor clinic and my insurance company drug their feet on remitting payment to them. So, Baylor turned around and invoiced me for $1250 and was ready to send that to collections. Turns out that the agreed rate with my insurance carrier for that vaccination was well under $100.
- maxsilver 12y ago
  It gets even worse than that. Some people are stuck with an HSA. A HSA is not insurance (it covers nothing), but it looks like insurance (so hospitals still charge you the 'ten times more' price). A $100 doctor visit, becomes $900 "charged" to your HSA (because you 'have insurance' so they can eat the artificially-inflated cost). But since HSA never covers anything, the insurance always just passes that $900 bill on to you. They stamp "THIS IS NOT A BILL" on the top, but that's a lie, it always requires you to pay money. You call up the hospital and explain "I don't have insurance, I need the sane price." They say "we can't give you that price, you have insurance." No one in healthcare understands that HSA's aren't insurance, and cover nothing, so no one will let you pay a manageable sum of money.

HarryHirsch 12y ago

With bogus physician bills my SOP is to call the office and tell them that I will let the bill run to collection and dispute it in court. This strategy never failed, physicians are mortally afraid of having to admit that their billing practice is questionable. With refunds from the insurance company I have found that a nice letter "please pay up 10 days from now or I will get a title in court" works wonders. I never had to no, not once.

korzun 12y ago
A mature way to handle this is to ask for a copy of the bill for clients that are paying directly, without insurance. Please don't take me to court now.
lilsunnybee 12y ago
More likely, doctors are very averse to lawsuits, and would sooner provide care to one patient at a loss than defend against a lawsuit, especially when it doesn't seem like a bluff because you seem like someone who could afford it (not typical btw).

shepardrtc 12y ago

This seems similar to third-party warranty companies. They offer full coverage for low amounts, but when the time comes for them to pay up, they're impossible to deal with. Can't reach them on the phone, they need things to be faxed(!) over, and then because of so-and-so reason, it won't be covered. Healthcare shouldn't be handled by startups. Its too expensive and there's too much riding on it for something that could go belly-up at any moment to handle. Of course, that brings up the question: How do you actually start an insurance company? I'd imagine that in a perfect world, the government could guarantee your coverage until you get enough in your coffers to handle things without a backup.

sp332 12y ago
Can you buy a good after-market warranty? I mean the dealers must be getting their first-party warranties from somewhere.
- shepardrtc 12y ago
  Perhaps, but I've never seen one. Though I suppose getting an extended warranty from the manufacturer is in the same vein. And dealers work more naturally with the manufacturer so there's usually less headache.
flatline 12y ago
I've talked to a couple health-care startups on the East Coast that have started by tackling one small aspect of healthcare and built off of that. Prescription drug tracking. OR procedures and checklists. There are tons of companies in the medical startup space that are doing good work, there are tons of areas that traditional big tech companies have failed to innovate in that are ripe for being upset. Playing fast and loose with insurance claims sounds more like outright fraud.
- commandar 12y ago
  >I've talked to a couple health-care startups on the East Coast that have started by tackling one small aspect of healthcare and built off of that. Prescription drug tracking. OR procedures and checklists. There are tons of companies in the medical startup space that are doing good work, there are tons of areas that traditional big tech companies have failed to innovate in that are ripe for being upset. While this is true, one of the problems currently being faced by the industry right now is that all of these niche vendors have their own ideas about how data should be handled, and it's resulted in a fair amount of balkanization of the healthcare IT industry. It's getting better, and HITECH and the ACA are finally pushing toward real standardization and data interchange, but from where I'm sitting (working in healthcare integration), it's probably going to take us another decade to sort out the mess things are in today.

eggbrain 12y ago

I had a conversation with a friend recently who was a doctor. He was telling me that he had 3 patients in a fairly short period of time that had come in with mysterious symptoms (they were all in their 70's) and that had died soon after being admitted. While he knew that he had technically done everything by the book to treat them, he worried that he had made a mistake along the way that possibly could have been the cause of their death. It made me appreciate that the code that I produce as a web developer most of the time would never have me facing those same ethical dilemmas -- there are very few times a bug in a web app would cause people to die or to be financially ruined. In this case, however, you can see what happens when an ambitious startup ends up trying to apply things web developers had done for years (A/B testing, "design" decisions) to avenues of life where people's livelihood or health is at stake -- people can end up getting hurt. "Failing hard and fast", the motto many people have regarding startups, cannot be taken with the same arrogance. If you want to change the world in ways that impact people on a personal level, be ready to be very careful with the trust your customers put in you.

famousactress 12y ago
Absolutely. I've been in healthcare for a bunch of years (I dunno, sheesh, I guess like 14?). For a big stint of that I built systems that aim to prevent medication errors in hospitals by telling clinicians when doses were due, etc. I know of at least two incidents where code that I wrote failed in a way that (due to some edge-case concurrency in one case, and daylight savings time in another case) didn't make it clear to a nurse that another nurse had given a medication to a patient and the patient received a double-dosage of a pretty severe drug. Imagine getting that call. It's every bit as fucking terrible and humbling as you'd think. Far more numerous (thankfully) were the calls that we got reporting that we stopped double dosages or even order-of-magnitude label misreadings on drugs. I know of more than a handful of instances that code I wrote may have literally saved a life. I've been lucky to have found myself at companies that take this stuff really, really seriously. It's a really hard balance to strike when failure is as devastating as it can be in healthcare, but the status quo is pretty terrifying also. In general every health IT shop's culture finds some balance between making decisions based on fear, and trying to achieve a velocity that allows problems to be fixed quickly and the greatest positive impact possible against the problem they're solving. I talk to a lot of people who want to work on "big/real problems" and list "healthcare" as one of them but when it comes down to it are often pretty freaked out about the stakes. It's weird to be used to the gravity of it, I certainly am now. I can't even wrap my head around what it would mean to work on something that doesn't hurt people when it fails.

r0m4n0 12y ago

With a healthcare startup, you will almost always pay more. Large insurance companies are able to bargain the best rates through many means based upon their size. Even when the provider disagrees (with capitated services for example) and bills the member, the larger insurance companies will reimburse the member and then bill the provider.

rlvesco7 12y ago

I'm sorry but I've had all these problems and many more with traditional health care companies. As a diabetic I'm intimately familiar with the health care system. It's a hard space to work in and I'm happy to see startups trying to tackle it. But it won't solved soon. Unlike Dropbox, where they "solved" sync more or less there is no one thing in health care, but many.

GotAnyMegadeth 12y ago

Sorry for over repeating what people always say, but I am genuinely so grateful for the UK's NHS.

arethuza 12y ago
I get private healthcare in the UK through my job - the only time we have used it was when my teenage son got his tonsils out. What was amusing was that at one point the anaesthetist came up and said there had been a mistake in the billing and I'd have to pay part of the bill directly. Having heard all the horror stories from the US I was thinking it was going to be a huge amount of money - he very apologetically gave me a bill for £12.00 (yes, twelve pounds) :-) [NB Worth noting that although we do have private health care, anything serious that has happened to us over the last few years was fixed by the NHS].
- lilsunnybee 12y ago
  You smug bastard. Joking, but i'm in the US and have had so many issues in my life with huge medical bills and debt collectors, denial of care, insurance refusing to pay because a doctor messed up the paperwork, insurance not covering certain medications, or saying the dosage needed to be changed, that i'm almost not. :-p
  - arethuza 12y ago
    Well, as anyone will tell you who lives in the UK, the NHS isn't perfect, but I personally happen to think that the model we have of a pretty good health care system for everyone and private health care for the tiny minority who want it seems to work fairly well. Mind you the NHS is socialism... but perhaps telling that the founder of the NHS, Aneurin Bevan, called his book on the subject In Place of Fear - which sums it up really. http://en.wikipedia.org/wiki/Aneurin_Bevan http://en.wikipedia.org/wiki/Aneurin_Bevan NB I find illnesses and injuries in a family stressful enough to deal with as it is - adding bureaucracy and financial stresses would be a nightmare.

joshfraser 12y ago

The problem with insurance companies is that they are fundamentally conflicted. As for-profit businesses they have a fiduciary responsibility to maximize profits. Unfortunately the only way to maximize profits is to decline coverage. The problem with Obamacare is that it does nothing to fix this problem. Who wants to be the guy responsible for that many lost jobs?? So, instead they propped up the insurance companies and made everything more complicated for everyone. The only solutions I see are to have non-profit insurance companies or a single payer system.

sova 12y ago
well said! what do you mean by single payer system?
- joshfraser 12y ago
  Single-payer health care is a system in which the government, rather than private insurers, pays for all health care costs. http://en.wikipedia.org/wiki/Single-payer_health_care http://en.wikipedia.org/wiki/Single-payer_health_care
ceejayoz 12y ago
Many of the insurance companies are non-profits, but that doesn't help much. http://seattletimes.com/html/localnews/2017460805_surplus09m.html http://seattletimes.com/html/localnews/2017460805_surplus09m...
r0m4n0 12y ago
https://www.blueshieldca.com/bsca/about-blue-shield/health-reform/our-involvement/healthcare-quality-value/our-pledge.sp https://www.blueshieldca.com/bsca/about-blue-shield/health-r... One of california's largest health insurance companies is a not for profit and doesn't stockpile money. why is healthcare still expensive?
- ceejayoz 12y ago
  Remember that that pledge can be fulfilled by increasing employee (i.e. CEO) salaries, nicer buildings for the company, etc. That's what's happened at our local BCBS affiliate.

kjjw 12y ago

"So I went to my new Oscar-approved doctor, who recommended routine blood work. The hospital called up Oscar and Oscar's operations department assured both the in-hospital labs and administrators that this blood work would be covered by my plan so we went ahead with it." Urgh American health care is just so weird. It makes my skin crawl.

cryoshon 12y ago
If by weird you mean terrible and dehumanizing, you're entirely right. It's designed to rape the most money away from sick people while providing them just enough care to keep them alive and needing more care, and thus spending more money. It's also designed to be extremely expensive even for those who are healthy by artificially inflating the costs of routine stay-well procedures and testing on top of the ridiculous monthly fees. And you can forget preventative medicine or any cutting edge treatments unless you're flush with cash.
- Shivetya 12y ago
  the design is handed down by government mostly, because of the bewildering number of laws, regulations, and such, that have wrecked havoc in health care for years. Then to top off whatever mess the Federal government makes each state just has to be enough different that what you bought in one state might not be exactly the same in other; used to be (and might still be) that you could not shop across state lines because of government. Then once you pass that insurance hurdle that regulation/regulators/insurance companies put up its off to the races with the doctors and facilities who may both not be covered by policies again because of the weird way regulations and such work. What can and cannot be performed by who and where it can and cannot be performed. The the kicker, using low payouts of medicare and such because the government knows the insurance companies and hospitals will make it up on people who can pay thereby redirecting the ire
jjoonathan 12y ago
It's evil, inconvenient, and (amazingly) it's even less efficient that its government-run counterparts both inside and outside the US: http://healthcarereform.procon.org/view.resource.php?resourceID=004083 http://healthcarereform.procon.org/view.resource.php?resourc... What will it take to convince people of this? Our society already accepts that markets aren't a suitable medium for every human endeavor, how long must we continue to experiment with private (basic) health insurance before we add it to the list of exceptions? If our health sector ran as efficiently as everyone else's (as a fraction of GDP/capita), the money we currently pay for medicare and medicaid would suffice to provide universal coverage for every single person in the US. http://healthcarereform.procon.org/view.resource.php?resourceID=005522#III http://healthcarereform.procon.org/view.resource.php?resourc...

kenrikm 12y ago

This story seams par for the course when dealing with insurance companies regardless of if it's startup or not. I've had the same exact issue with everyone from "United" to "Humana" and more recently "HealthNet" You will be told something is in network and it's not, a lab location is listed on their website as in network and then they claim it's not covered later. Sadly, this seems to be an area where legislation needs to bring out the big stick and force them to cover services that they had listed as "in-network" bad data is no excuse.

lilsunnybee 12y ago
Wish more people knew this. A lot of professionals on here might personally have a stellar health insurance plan through their employer that covers almost anything no questions asked, but those same big insurers will administer cut-rate plans to the majority of plan-holders and deny payment at the drop of a hat, or pick and choose what necessary care / medications they will / won't pay, often after the fact, seemingly arbitrarily or if submitted paperwork isn't flawless. It's a pretty good racket really; provide quality, hassle-free coverage to the high income, professional class, or anyone else that might have any say or sway or influence in government, and then for the working class majority refuse to ever pay out more per person than you are payed. That way you can cost-save like crazy and make obscene profits, but no one that matters cares and based on their experience it just looks like belly-aching and blowing things out of proportion.

jnardiello 12y ago

From the Oscar front page: "Free doctor visits via phone". WTF is this? How can a doctor visit by phone? All this story is just a smell on how deeply broken the entire US health system is (together with all the healthcare-systems of 3rd world countries).

k-mcgrady 12y ago
I could see this being really useful. There are many times I have needed questions answered by the doctor (e.g. I've been diagnosed with x - can I still do y safely) and the only way is with an appointment which wastes both our time. I wish my local GP would set aside 1 hour per day to answers questions via email or phone. It would make things much more efficient.
- fr0sty 12y ago
  The issue with that, is there's no good way for the doctor to get paid for doing it. Prior to 2009 there was no billing code for phone calls or email and currently the rules around what is a "billable" consultation are complex and the coverage by insurers is far from uniform. More info here: http://patients.about.com/od/followthemoney/f/Why-Doctors-Wont-Telephone-or-Email-Patients.htm http://patients.about.com/od/followthemoney/f/Why-Doctors-Wo...
  - k-mcgrady 12y ago
    I was thinking more about my own healthcare system where the government pays the doctor. So his salary would just stay the same. In the US or other systems like it I can see how that would be an issue.
    - walshemj 12y ago
      well use something like the UK model where dr's can have both a NHS contract plus private patients.
lotharbot 12y ago
This was part of the coverage I had with QLiance in Seattle. I could send an e-mail or call my doctor on the phone and get a prompt response. At one point we went from "noticed problem" to "discussed via e-mail" to "at the clinic being treated" in an hour. Other times, we'd notice a problem and solve it entirely via e-mail or phone, and save the clinic visit entirely.

jackgavigan 12y ago

There is, sometimes, a tendency on the part of young, ambitious entrepreneurs, to be overly optimistic and assume that they can gatecrash an industry they know nothing about, set up a slick website and disrupt the big, bloated, uncool incumbents. Sometimes that works out but I believe that a new entrants chances of success are a lot higher if they have somebody on board who is actually familiar with the industry sector they're trying to disrupt. None of Oscar's founders have worked in health insurance previously. They come from tech entrepreneur/VC, consulting and technology backgrounds. Edit: Here's a good example of where some industry expertise might have been useful: "..it was a design decision to limit the information presented to hospital's on what is covered in detail (like inhouse labs)." There's currently a big trend in design towards making things simple. But there's a difference between making stuff simple and dumbing it down. Sometimes, stuff looks complicated because it's complicated.

brandnewlow 12y ago
I think that's an overly generous assessment. Oscar's founders have invested incredible sums of money into the company and are very well connected. If they've not hired people who know the insurance industry, it's safe to assume it's because they chose not to. This is not a small scrappy startup. This is a company started by powerful people looking to get into an opening they saw.
lsc 12y ago
I have Kaiser. It's vastly simplified because the people paying for my care are the same people who are providing my care. They also seem to have a real "get you up and running so you can get back to work" kind of attitude, which meshes well with my own values. I mean, consider for a moment how much of a pain in the ass it is to get an insurance claim on your house or your car or whatever filled. Multiply that by the complexity of medicine, and... yeah. You can see how it would get complex fast. Maybe this is an area where horizontal integration is the order of the day?
- chaostheory 12y ago
  Kaiser is great. The problem is with Kaiser is that it's not available nationwide. If I remember, it's only available in big metros.

dangerboysteve 12y ago

Why not link directly to the article than that slow feed site? http://valleywag.gawker.com/what-happens-when-a-healthcare-startup-leaves-you-with-1598186714 http://valleywag.gawker.com/what-happens-when-a-healthcare-s...

atestu 12y ago
Because valleywag is a banned domain on HN for some reason

greenyoda 12y ago

In the U.S., insurance is regulated by the states and each state has a regulatory agency where one can go with complaints about insurance companies. I find it surprising that the abused customer in this story didn't file a complaint with the government. That would have probably made the insurance company stand up and take notice much more than complaining about them on Twitter.

lilsunnybee 12y ago
I never knew this, and sincerely doubt most people do. But besides this rare start-up, if you're an established player like Blue Cross, does one or dozens or even hundreds of complaints even matter?

DatBear 12y ago

>In the emerging health and wellness markets, startups like Oscar intimately disrupt and destroy their customer's lives through incorrect datasets where an A/B testing mentality results in exorbitant fees, angry hospital administrators and patients with no recourse except to bankrupt themselves paying bills they didn't expect. This doesn't make sense to me. How is an A/B testing mentality at fault for this? It has nothing to do with the incorrect datasets... you don't A/B test your data structure... I hope. A/B tests are blamed later in the article too, not really sure why.