Opinions expressed by Contractor the contributors are theirs.
Medical debt is the leading cause of bankruptcy in the United States and currently affects nearly a third of American workers. Limited in options and filled with desperation, a quarter of a million Americans run campaigns on GoFundMe or solicit community-supported funds to try and cover medical expenses each year.
Clearly, there are opportunities here for healthcare entrepreneurs to build businesses that tackle these glaring issues and help consumers in this struggle.
1. Be clear about the benefits
The descriptions of the benefits are incredibly long, detailed, and tedious. Receiving care from providers or off-grid facilities is a common circumstance that results in patients being burdened with a huge bill. More than two-thirds of Americans don’t know when they are receiving out-of-network care.
The federal No Surprises law, which comes into effect on January 1, 2022, protects patients against “surprise medical bills” from off-grid providers at network hospitals. It’s a good start, but more is needed.
There is an opportunity here for a company to make all of these scenarios transparent. Imagine if the benefits were simplified and easy to understand or, better yet, if we could just get the price of a service up front and pay for it without the involvement of a third party.
2. Cost forecast
I always encourage anyone undergoing a medical procedure to ask in advance what it will cost. The supplier may not give you a specific amount, but it’s worth it. Correspondence in writing can also give you a stronger argument if you need to challenge the bill after the fact.
There are hospitals, like Wooster Community Hospital in Wayne County, Ohio, that are transparent and offer fair prices to patients. They provide a tool for estimating the cost of care, make their financial aid plans easy to understand and use, and include an explanation of their chargemaster and a price list on their website.
We, as healthcare buyers, need to start demanding these tools and information for all providers. This will force a change in hospital billing and collection practices.
3. Financial assistance schemes
Most people are unaware that they can qualify for discounts of up to 70% or more at nonprofit hospitals based on financial assistance plans (FAP). Nonprofit hospitals are required to offer substantial discounts to patients who meet certain income requirements, which are higher than you might think. However, most hospitals make it difficult to find the forms, fill out the forms, and ultimately access the discount. Simplifying the FAP presents a major opportunity for entrepreneurs.
4. Price transparency
The Centers for Medicare and Medicaid Services implemented a price transparency rule on January 1, 2021, which requires hospitals to list their prices for commonly used codes with major insurers and for patients paying in cash. Like any regulation, the details are quite complicated and hospitals have interpreted these complexities to their advantage. Others have decided not to comply and simply pay relatively small fines.
This regulation created an opportunity for entrepreneurs to collect information on hospital tariffs, validate them and make them easier to use. However, given the hospital’s lack of compliance, we are only in the early stages of making this vital information available to all consumers.
5. Cash pricing for patients
There is a growing but fragmented industry that thrives simply to provide access to care at an initial cost without depending on a health insurance company. These companies focus on outpatient surgery centers which can provide access to surgeries at a higher price and quality than many hospitals, expensive drugs often purchased in other countries, diagnostic services and FAP programs. .
This area will continue to evolve. Entrepreneurs should develop a treasury network for all medical services, which already exists for generic drugs. The end goal of this type of business is to completely eliminate the need for health plans and dramatically reduce the cost of health care while making it easier for hospitals and doctors to pay.
Related: Warren Buffett Tried To Kill The “Tapeworm” In Health Care Costs, But Couldn’t Do It. Maybe entrepreneurs can.
6. Invoicing (in) accuracy
By some estimates, 80 percent of medical bills contain errors. It’s an amazing statistic that should make everyone skeptical about every bill they get. Insurance companies have auditors who correct bills to reduce costs. The patients are alone.
It is essential that corrections be made soon after the invoice is issued. If he goes to the collections, it may be too late. You can often settle with collections for 10 percent of the total bill, but there’s a chance your bill should have been 90 percent lower anyway.
It seems there should be a market for independent auditors of consumer medical bills. The big healthcare payers wouldn’t dream of not auditing. Individuals need the same protection, which creates an opportunity in the market.
Related: The Future of Healthcare is in the Cloud
Back to basics for a better future in healthcare
People across the country see their lives turned upside down every day because they received care from an off-grid provider, don’t know FAP programs exist, and can’t access a price for a service they buy. . And while patients can cover their risk of medical debt, it is up to the healthcare industry to stop it.
There is a huge need and desire among consumers to be protected from medical debt. I would go so far as to say that the major players in the industry should pay to settle patient medical debt until they fix the problems with the current system, which earns them billions of dollars every year.
Ultimately, we need to re-focus on the core function of each actor and address these issues by reinventing one health system at a time. Hospitals exist to treat people. Part of that care should include not leaving their patients in financial shambles. We need to prioritize the patient and simplify the process.
Insurance companies have only one job, which is to cover the cost of healthcare when a person falls ill. Medical debt is not someone else’s problem. This is our problem, and it is our responsibility to put an end to it.
Related: Top 3 Medical Device Stocks To Buy Now