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HEALTHdrum: Questions & AnswersAs a radically new concept in handling the cost of healthcare, Healthdrum wants to address some of the most common questions we receive from our visitors.
A. Essentially, cash price, self pay, direct pay, free market care means eliminating insurance companies and insurance plans and paying a healthcare provider directly for their services. Many non-emergency medical specialties have adopted this method of running their practices. These clinicians opt to not take health insurance and instead bill the patient the reasonable, actual cost for the service/treatment. Patients then “directly pay” for the care received. Cost transparency is the clear-cut fees healthcare providers will charge for services. This means there is no need to decipher medical coding on invoices to figure out what you are being charged for care and treatment. With cost transparency, physicians and clinicians set fees for their services and they are available for patients to see in advance.
A. HEALTHdrum is an online platform that promotes the benefits of direct pay and cost transparency for patients, clinicians and employers. Physicians who opt for the direct pay method of running their practice can list their services on HEALTHdrum. In return, patients who are in the market for a direct pay healthcare provider can find the clinician that is right for them by using HEALTHdrum. Employers, especially small businesses or self-employed, can also use HEALTHdrum to learn the benefits of foregoing insurance plans for employees and instead connecting them with direct pay physicians.
A. The health insurance industry is disliked by many. This is mostly because, while we go into choosing a health plan with the belief the insurance provider has our best interests at heart, we quickly learn that this is rarely the case. Not only do health insurance plans limit treatment coverage, restrict access to certain providers and facilities, we are often still left with medical bills to pay. Many of us pay weekly, bi-weekly or monthly into expensive health coverage that offers us very little freedom when it comes to our own care. By choosing to forego health insurance and instead visit with direct pay physicians, you will have complete control over any treatment you receive. In addition, if you are relatively healthy like most millennials, you should save money with consumer directed care.
A. The current healthcare process is very inconvenient, very costly, grossly inefficient and benefits mostly the insurance company. Using direct pay solutions, patients can bypass the endless insurance rules, restrictions and profiteering middlemen. Plus, most healthcare needs can be delivered affordably through doctors’ offices and outpatient clinics without the need for health insurance. Returning to consumer-directed choice for healthcare can actually help reign in out of control healthcare costs. Consider that this process is already working well for most, if not all, cosmetic, weight-loss and infertility care services. Consequently, because customers pay for these services, providers are strongly incentivized to offer competitive prices. For the most part, this approach to doing business has resulted in a dramatic reduction in care costs. If cost-transparency and market forces were used in the delivery of routine as-needed, non-emergency care, their costs would also likely be driven down. With a realignment of health insurance plans to cover only childbirth and catastrophic events, healthcare consumption would return to being driven mainly by patient need and demand.
A. The value of digital healthcare to the patient is cost-transparency, choice and a 24/7 as-needed availability. A platform, like HEALTHdrum, is particularly valuable to those without health insurance, like part-time workers, gig workers, the self-employed or those who want to budget and manage their own healthcare needs. This way, they can bypass the cost of the health insurance plans and their endless restrictions and limitations. The value to the physician/provider is fast payment, no claims review, no claims denial, no lost claims, no need for pre-authorizations and, reduced billing and scheduling costs. Currently, physicians are dealing with increasing overhead costs and drowning in a sea of pointless rules. Insurance companies control almost everything in healthcare - from medications to testing and treatments. A digital healthcare platform like Healthdrum is the way for customers and providers to reclaim their independence and get rid of the exploiting gatekeeper.
A. First and foremost, when talking about routine healthcare, take the time to shop around and find the physician and healthcare facility that is right for you. Most physicians, specialists, urgent care and outpatient clinics offer affordable healthcare. Therefore, we can feel comfortable asking for the cost of tests and treatments in advance. We can also request reduced rates and negotiate healthcare pricing. It’s important to get an idea of costs before seeing a physician. Be sure to find out what is involved with the test or treatment that is being performed. Also, there are other options to help in handling the costs of care, such as healthcare sharing ministries and medical tourism.
A. We certainly can’t plan for the unexpected and until the health insurance companies choose to offer catastrophic coverage plans there are options. Here are some ways to handle the costs:
  • Set up a monthly payment plan
  • Seek a billing advocate
  • Ask the hospital (if non-profit) for financial assistance
  • Find government and state assistance programs
  • Look in to a personal loan
  • Cash in a life insurance policy
  • Apply for a health credit line
  • Crowd-funding
If a medical emergency does occur and healthcare bills begin to arrive, it’s important to look for certain things on the invoices that can be red flags, including billing errors, mismatched coding, unbundling of services, and even duplicate billing.
A. Insurance companies spend a tremendous amount of money on generating the tsunami of online material designed to frighten everyone into buying health insurance. Take Medicare Advantage and All-in-One for example. These types of Medicare health plans are offered by private contracted companies to “manage” your care. With the help of tricky marketing, you get the impression that “everything” is paid for and “better” than a conventional Medicare plan. In fact, the truth is that you are often left very disadvantaged. Money received from the government to “manage” your care allow these companies to subtract their profit margin and overhead costs. After restrictions and limitations, you are left with a very watered-down Medicare plan totally under their control.
A. Ultimately, insurance plans lack cost-transparency and have endless rules, restrictions, limitations and exclusions, which help to ensure profitability. Also, most plans come with non-covered items and pre-existing condition clauses that simply add to your out-of-pocket costs. HMOs and PPOs can put the insured in jeopardy of high fees that are generated by unnecessary testing and treatments. In contrast, capitation plans can put people at risk by potentially exposing them to delayed or withheld care. Medicare plans are also highly susceptible to fraud. There are multiple ways to siphon off healthcare dollars from government sponsored programs. In fact, it is estimated that one in ten dollars delivered is fraudulent because of intentionally incorrect coding, unnecessary services, double billing or the use of fictitious names.
A. Remember, this is a business… an industry… they are not worried about you or your current health situation. Instead, they are more concerned about improving their profits and bottom line. Insurance plans cover only 70 - 80 percent of the cost of care, you wind up paying the remaining 20 - 30 percent. Furthermore, there can be non-covered services and or pre-existing conditions claimed by the insurance company. You end up paying for those too - and, you continue to pay for the “privilege” of having the insurance plan. You soon realize that despite the insurance company’s clever marketing about covering hospitalization your 20-30 percent portion of those costs is going to break the bank, whether you have health insurance or not. Once you are home recovering, you’ll receive a summary of payments made to providers on your behalf. The insurance company will let you know what they think should be an “allowable” cost for a service, and they underscore what you’ve “saved”. This is a misrepresentation. Not only has your healthcare plan worked you over for payments, they have squeezed all the clinicians providing services to “accept” lower payments. These so-called savings simply go to the plan’s bottom line.