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.
What Happens When a Healthcare Startup Leaves You With the Bill
61–70 of 96 posts
Re: What Happens When a Healthcare Startup Leaves You With the Bill
#62There 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 sect…
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. Also, disrupting American health insurance is like "disrupting" terrorism. (It took 10 years to get one guy.) It's not something you can pull off in an afternoon. You're fac…
I think that it's generally a good assumption, anywhere in business (and most places in life), that whoever you're talking to is self-interested. Not evil, not even necessarily selfish, but it's a good bet that their world revolves around them.
And once you've got this principle ingrained in your mind, navigating the big scary world of business, or VC, or Google, or health insurance, or any other industry becomes much easier. Because you start to look for what people's incentives are, and don't ask them to do things that are against their own incentives. People are much more inclined to cooperate with you when it doesn't hurt their own interests.
People who actually "disrupt" industries, rather than just talk about it, do so by finding loopholes in other folks' incentive structures. They figure out other ways of doing things that incentivize everybody involved to cooperate with them, and that's how they revolutionize things.
Re: What Happens When a Healthcare Startup Leaves You With the Bill
#63I 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://pfccm…
I have to have a set of bloods 5-6 tests every 6-8 weeks plus 4 quarterly ones for the royal free as a result of my condition - god only knows what that would cost in the USA as people say bless the NHS
Re: What Happens When a Healthcare Startup Leaves You With the Bill
#64Earlier quoted context omitted.
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-Wo...
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.
well use something like the UK model where dr's can have both a NHS contract plus private patients.
Re: What Happens When a Healthcare Startup Leaves You With the Bill
#65I 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…
And when the code does matter, too many don't realize the importance of getting their shit straight.
Privacy and user information is a "light" example, but a very basic one that should instill a bigger sense of responsibility than most developers have.
Re: What Happens When a Healthcare Startup Leaves You With the Bill
#66"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.
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?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 befor…
> 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.
This isn't an apples-to-apples comparison for several reasons (some which overstate the amount of money, some which understate).
One, there are a number of things which fall under Medicare's budget which you and I wouldn't think of as the "main" purpose of Medicare in this context (ie, providing medical insurance to the elderly).
On the other hand, look at the profit margins of any hospital broken down by insurance status. Virtually any hospital hemorrhages money on uninsured patients, Medicare patients, and Medicaid patients. They make this up by charging patients on private insurance, and in the end eke out low single-digit profit margins if they're lucky (most aren't). If you're on private insurance, you're essentially subsidizing the medical care of the aforementioned groups (whether you pay it in the form of your deductible, or in the form of your premiums[0]).
As the largest payer, Medicare has the leverage in order to decide what it will and will not pay for, and providers have very little choice but to accept that, whether or not it's economically feasible for them. (This is the exact inverse of the situation most of us are in with our ISP/cable providers (we have an essential monopoly on broadband access in most parts of the US). When there is a single purchaser, this is known not as a monopoly but as a monopsony[1])
It's easy to say that "costs are too high" - that's fine, but where are they too high?
The easy response to this is that hospitals and doctors are making too much money. But in reality, most hospitals are struggling just to say solvent, which is why we've seen massive consolidation in hospitals in the last several years as hospitals go out of business. The same is true of doctors, who are selling to these larger hospitals because their private practices are now financially unsustainable[2]. Of course, this really just pushes the problem up the food chain, because those same hospitals are already struggling to keep the lights on.
I don't really have an answer to this, by the way... I just want to relay an appreciation of why the situation hasn't been fixed yet - it's very complex, and nearly every option involved has significant, serious tradeoffs that nobody really wants to address (whether for political reasons, ethical reasons, or otherwise).
[0] Remember that the size of your premiums are (loosely) linked to the expected value of providing medical care for you. Mathematically this is trivial to show - in reality, the market isn't so efficient, but it's simple enough to say that if your insurers' costs go up, in the long run, your premiums will as well.
[1] https://en.wikipedia.org/wiki/Monopsony
[2] This 116-page report gives a very extensive analysis of the economic state of physicians. Don't be fooled by the title - this trend began long before the ACA, even though the scope of this study was the impact of the ACA specifically (which has contributed to the trend which previously existed): http://www.physiciansfoundation.org/uploads/default/Health_R...
Re: What Happens When a Healthcare Startup Leaves You With the Bill
#67Earlier quoted context omitted.
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 $1…
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…
HSAs are, by legal requirement, only available if you are enrolled in a High-Deductible Health Plan [1], which is insurance and does pay for something, though (as the name suggests) it has a very high annual deductible (for which the HSA is used).
So if you have an HSA, you do, in fact, have insurance.
Re: What Happens When a Healthcare Startup Leaves You With the Bill
#68Earlier quoted context omitted.
I always see this claim that companies have to try and maximize profits. Where does that originate? I see many companies like Costco take long term paths to sustainable growth and success without trying to wring every penny of profit out of the business. In my opinion customer satisfaction, quality products, and employee growth and retention are far more beneficial goals than short term profit taking.
The law’s basic position on corporate social responsibility famously was articulated in Dodge v. Ford Motor Co. In 1916, Henry Ford owned 58% of the stock of Ford Motor Co. The Dodge brothers owned 10%. The remainder was owned by five other individuals. Beginning in 1908, Ford Motor paid a regular annual dividend of $1.2 million. Between 1911 and 1915 Ford Motor also regularly paid huge “special dividends,” totaling…
In the last 20 years of judgments, how many times has this decision been cited?
Re: What Happens When a Healthcare Startup Leaves You With the Bill
#69Earlier quoted context omitted.
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?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 befor…
> 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. This isn't an apples-to-apples comparison for several reasons (some which overstate the amount of money, some which understate). One, there are a number of things which fall under Medicare's budge…
>This isn't an apples-to-apples comparison.
It really is, and has nothing to do with the current state of Medicare and what it covers. Our per-capita government health care expenditures are far higher than systems that both have better outcomes and that also don't charge at the point of delivery.
Our doctors make twice as much as everyone else's doctors, and that is only sustained because they are both protected from competition from foreign doctors, and also restrict supply domestically. Our drugs are 10x the prices paid in other countries. Our broken patent system contributes to massively bloated prices in medical devices.
We wouldn't have a government budget deficit if our system was as efficient as any other system in the developed world. The saddest thing is that in after our government spends more than everyone else, we as individuals then go out of pocket even more, and the majority of our bankruptcies and foreclosures are a result of medical difficulties. I would go on, but all of this is as boring and obvious as it is ultimately unsustainable.
http://www.cepr.net/calculators/hc/hc-calculator.html
edit: http://www.cepr.net/index.php/blogs/cepr-blog/fixing-our-fis...
Re: What Happens When a Healthcare Startup Leaves You With the Bill
#70Earlier quoted context omitted.
I always see this claim that companies have to try and maximize profits. Where does that originate? I see many companies like Costco take long term paths to sustainable growth and success without trying to wring every penny of profit out of the business. In my opinion customer satisfaction, quality products, and employee growth and retention are far more beneficial goals than short term profit taking.
The law’s basic position on corporate social responsibility famously was articulated in Dodge v. Ford Motor Co. In 1916, Henry Ford owned 58% of the stock of Ford Motor Co. The Dodge brothers owned 10%. The remainder was owned by five other individuals. Beginning in 1908, Ford Motor paid a regular annual dividend of $1.2 million. Between 1911 and 1915 Ford Motor also regularly paid huge “special dividends,” totaling…
Ford's real motivation was to keep money out of the hands of the Dodge brothers - he thought they were going to use the dividend money to start a rival automaker, and he was right.
The court ruled against Ford because he was acting in bad faith towards his shareholders, not because it's wrong for a corporation to accumulate assets and reinvest in its business instead of paying dividends. (Otherwise Steve Jobs and Warren Buffett would be in trouble...)