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Having dealt with health problems this past year, I would love to see somebody write something that simplifies the voodoo going on between health care providers

Having dealt with health problems this past year, I would love to see somebody write something that simplifies the voodoo going on between health care providers and insurance companies. Even though they both have online portals these days, trying to reconcile and make sense of the two systems is infuriating.

ThomPete 11y ago
I second this. I was diagnosed with a melanoma a couple of years ago. Luckily early stage but had to deal with several hospitals and dermatologists who just doesn't talk with each other, add to that the complexity of insurance-agencies and the fact that I have more than a thousand of those little bastards and you begin to see the potential for mistakes and the stress that might incur on a lot of people. Whoever could solve this would be someone I would pay money.
jewel 11y ago
Can you go into more detail about the pain points? I imagine there are lots of readers who have been blessed to not have major medical issues on their own insurance yet and might not be familiar with the process. I know that when we had our last baby we received mountains of paperwork in the mail, but since my wife used to work as a claims adjuster she dealt with all of the issues. (We ended up getting overbilled by $3k.)
- jakejake 11y ago
  Well the biggest problem seems to be that the billing from the health provider doesn't sync up with insurance. So you'll get a bill like "you owe $1,295" but there's absolutely no way to reconcile this with the services you received. You can call your provider and they'll try to provide you with a detailed invoice (maybe if you're lucky). If you argue long enough with both then eventually you might get somebody to make some type of adjustment but even still it's random. At the end of the day you might wind up paying $500 just because you figure that's as good as it's going to get! This is probably a difficult problem to solve, but one thing that might be possible is just a way to look up the bill and translate the insurance "codes" that are meaningless to normal people and require looking up in various medical or insurance sites. Like code 123456 means you had your blood drawn. Or code 67890 means they ran some test, etc. It takes forever to look this stuff up.
  - waldoh 11y ago
    The codes aren’t meaningless or arbitrary. Think about how many different types of “office visits” there are. Forget about any services performed DURING the office visit, think about just the office visit itself. Walking into a room, talking with a medical professional, and leaving. It could be a 10 minute followup visit. You could be a new patient and they are establishing your history for their record, maybe that’s a 45 minute visit. You could be walking in to get a new prescription written. You could be talking to doctor to get a second opinion. You get the idea. My point is that these have varying levels of time spent and doctor-involvement, in which they would have different charges for. A 5 minute visit shouldn’t cost the same amount as a 60 minute visit, right? Each one has their own code, and even modifier codes on top of them (to indicate things like ‘left’ or ‘right’, when a particular procedure is performed on multiple areas) The codes allow them to record the service and bill as accurately as possible. Without them, instead of seeing a bunch of codes and wondering how that equals a thousand bucks, you would get a piece of paper that said “services performed: medical stuff” and a bill for a thousand bucks instead.
  - jakejake 11y ago
    @waldoh can't reply to you - you've been hellbanned. anyway, the codes are obviously not meaningless in general. As I wrote, they are meaningless to "normal people" meaning the patients. Having an app that just showed you the line items, with the explanation next to it would be a huge improvement. You're also talking about going to see the Dr for a cold or something. When you've had a major surgery and months of follow-up procedures with pages and pages of line items on your bill, hundreds of codes, disputes with things you think you have already paid, bills that don't match up with what insurance says, etc... then you'll understand what I'm talking about.
thetylerhayes 11y ago
Hey, friend just sent me a link to your comment. So two things: 1. we (Prime) are still in beta but happy to extend an invite your way if it helps—it'd allow you to connect all your patient portals and have the data synced in one place; 2. maybe more relevant to OP and HN at large, we released a new tool this morning called Patient Portal Finder: http://useprime.com/blog/2015/06/29/introducing-the-patient-portal-finder/ http://useprime.com/blog/2015/06/29/introducing-the-patient-... (sounds like you probably don't need this but just in case) I'll stick around the comments too but email me tyler@useprime.com anytime if I can help with this madness. Been through it way too many times myself.
- jakejake 11y ago
  Thanks a bunch - that looks interesting! my Doc wasn't in there but i'll keep an eye out.
Wonderdonkey 11y ago
Related to this, I was listening to an NPR program recently that tackled the question: If your pet's doctor can give you a list of pricing options before you decide on treatment, why can't your own doctor do that for you? The answer was that our doctors are disconnected from the costs of treatment because they can't be expected to know every possible charge for every different insurance plan (what the patient would have to pay for procedures, medicine, support staff [anesthesiologists who are out of network, for example], devices [pacemakers, wrist splints, artificial hips, etc.], lab fees, etc.). So why not something that can bring that information to them? This would be a benefit not just to consumers but to insurance companies as well, and that's where the money would be. Feel free to cut me in on the action.
- thetylerhayes 11y ago
  Directionally correct but slightly off. Vets don't memorize all that either; they also use EMRs. The difference is in insurance: 1. You pay directly for your pet's care. Your vet gets the money. No in-between to obscurify the money. 2. You pay insurance for your own care, and your doctor bills your insurance. Your doctor's EMR might know the insurance cost, but that cost can still change. And there are lots of middlemen in billing processing in healthcare, so it's not an accurate representation of reimbursement anyway. There are quite a few startups trying to remedy this in various ways. Most of them focus on data transparency; they try to aggregate and publicly list all the direct pay costs for different doctors. The problem with that remains the same: most people don't have the precedent in their head of paying for healthcare, so they don't want to pay direct. Not impossible to fix. Someone certainly will. Probably orthogonally, like how Slack is unbundling email. But the tech barrier is small compared to the social barrier. Would be pretty sweet if someone was able to map out all insurance costs though, even to 90% consistency. Hooo boy that would be sweet.
aj0strow 11y ago
OpenCare here in Toronto is working on this.

ThomPete 11y ago

I second this. I was diagnosed with a melanoma a couple of years ago. Luckily early stage but had to deal with several hospitals and dermatologists who just doesn't talk with each other, add to that the complexity of insurance-agencies and the fact that I have more than a thousand of those little bastards and you begin to see the potential for mistakes and the stress that might incur on a lot of people. Whoever could solve this would be someone I would pay money.

jewel 11y ago

Can you go into more detail about the pain points? I imagine there are lots of readers who have been blessed to not have major medical issues on their own insurance yet and might not be familiar with the process. I know that when we had our last baby we received mountains of paperwork in the mail, but since my wife used to work as a claims adjuster she dealt with all of the issues. (We ended up getting overbilled by $3k.)

jakejake 11y ago
Well the biggest problem seems to be that the billing from the health provider doesn't sync up with insurance. So you'll get a bill like "you owe $1,295" but there's absolutely no way to reconcile this with the services you received. You can call your provider and they'll try to provide you with a detailed invoice (maybe if you're lucky). If you argue long enough with both then eventually you might get somebody to make some type of adjustment but even still it's random. At the end of the day you might wind up paying $500 just because you figure that's as good as it's going to get! This is probably a difficult problem to solve, but one thing that might be possible is just a way to look up the bill and translate the insurance "codes" that are meaningless to normal people and require looking up in various medical or insurance sites. Like code 123456 means you had your blood drawn. Or code 67890 means they ran some test, etc. It takes forever to look this stuff up.
- waldoh 11y ago
  The codes aren’t meaningless or arbitrary. Think about how many different types of “office visits” there are. Forget about any services performed DURING the office visit, think about just the office visit itself. Walking into a room, talking with a medical professional, and leaving. It could be a 10 minute followup visit. You could be a new patient and they are establishing your history for their record, maybe that’s a 45 minute visit. You could be walking in to get a new prescription written. You could be talking to doctor to get a second opinion. You get the idea. My point is that these have varying levels of time spent and doctor-involvement, in which they would have different charges for. A 5 minute visit shouldn’t cost the same amount as a 60 minute visit, right? Each one has their own code, and even modifier codes on top of them (to indicate things like ‘left’ or ‘right’, when a particular procedure is performed on multiple areas) The codes allow them to record the service and bill as accurately as possible. Without them, instead of seeing a bunch of codes and wondering how that equals a thousand bucks, you would get a piece of paper that said “services performed: medical stuff” and a bill for a thousand bucks instead.
- jakejake 11y ago
  @waldoh can't reply to you - you've been hellbanned. anyway, the codes are obviously not meaningless in general. As I wrote, they are meaningless to "normal people" meaning the patients. Having an app that just showed you the line items, with the explanation next to it would be a huge improvement. You're also talking about going to see the Dr for a cold or something. When you've had a major surgery and months of follow-up procedures with pages and pages of line items on your bill, hundreds of codes, disputes with things you think you have already paid, bills that don't match up with what insurance says, etc... then you'll understand what I'm talking about.

thetylerhayes 11y ago

Hey, friend just sent me a link to your comment. So two things: 1. we (Prime) are still in beta but happy to extend an invite your way if it helps—it'd allow you to connect all your patient portals and have the data synced in one place; 2. maybe more relevant to OP and HN at large, we released a new tool this morning called Patient Portal Finder: http://useprime.com/blog/2015/06/29/introducing-the-patient-portal-finder/ http://useprime.com/blog/2015/06/29/introducing-the-patient-... (sounds like you probably don't need this but just in case) I'll stick around the comments too but email me tyler@useprime.com anytime if I can help with this madness. Been through it way too many times myself.

jakejake 11y ago
Thanks a bunch - that looks interesting! my Doc wasn't in there but i'll keep an eye out.

Wonderdonkey 11y ago

Related to this, I was listening to an NPR program recently that tackled the question: If your pet's doctor can give you a list of pricing options before you decide on treatment, why can't your own doctor do that for you? The answer was that our doctors are disconnected from the costs of treatment because they can't be expected to know every possible charge for every different insurance plan (what the patient would have to pay for procedures, medicine, support staff [anesthesiologists who are out of network, for example], devices [pacemakers, wrist splints, artificial hips, etc.], lab fees, etc.). So why not something that can bring that information to them? This would be a benefit not just to consumers but to insurance companies as well, and that's where the money would be. Feel free to cut me in on the action.

thetylerhayes 11y ago
Directionally correct but slightly off. Vets don't memorize all that either; they also use EMRs. The difference is in insurance: 1. You pay directly for your pet's care. Your vet gets the money. No in-between to obscurify the money. 2. You pay insurance for your own care, and your doctor bills your insurance. Your doctor's EMR might know the insurance cost, but that cost can still change. And there are lots of middlemen in billing processing in healthcare, so it's not an accurate representation of reimbursement anyway. There are quite a few startups trying to remedy this in various ways. Most of them focus on data transparency; they try to aggregate and publicly list all the direct pay costs for different doctors. The problem with that remains the same: most people don't have the precedent in their head of paying for healthcare, so they don't want to pay direct. Not impossible to fix. Someone certainly will. Probably orthogonally, like how Slack is unbundling email. But the tech barrier is small compared to the social barrier. Would be pretty sweet if someone was able to map out all insurance costs though, even to 90% consistency. Hooo boy that would be sweet.

aj0strow 11y ago

OpenCare here in Toronto is working on this.