4 ms·

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 insu

by 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.

by jewel 11y ago

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.