“I think our industry is ripe to be disrupted. And it’s going to be disrupted because there’s so much we do that doesn’t add value.” — Dr. David Feinberg, CEO Geisinger Health System
I received a bill in the mail. I owed $295 for my health wellness checkup, which included a physical and preventive blood testing. And my health insurer was not going to cover any of it.
This was like that feeling you get when you find money in an old pair of pants, but the opposite.
Mostly, I was surprised because I was previously told by my provider and an insurance rep who helped me schedule the visit that I would owe nothing — not even a co-pay — as in-network preventive care had been mandated as free by the Affordable Care Act since 2012. And if I did for some reason owe a copay, the visit should have costed $15 since it was scheduled for the Primary Care Provider listed on my insurance card.
But $295. Wow.
I was feeling particularly ambitious so I called the family office and asked about some of the billing and coding discrepancies. For example, the bill read as if I saw two different doctors — one on-site for a physical and another at a separate location for the blood work. In reality, I saw a Nurse Practitioner for my wellness checkup and a lab tech for my blood draw at the same location. Why wasn’t this made clear on the bill?
The office receptionist assured me that the way they coded the visit was standard. But there was no actual justification. We went back and forth on this and several other concerns for about 30 minutes. I asked her for a quick resolution but was told that if I had any issues with the bill, I should contact my insurer, because at this point there was nothing the receptionist could do to re-code.
My willpower to resolve this issue was starting to drop.
But I called my insurer.
After a 20 minute hold, I reached a rep and explained my situation in detail.
The rep responded that the two lab tests I got are not considered preventive services. I was assured during the visit that I was only getting preventative tests.
She explained that the preventive exam and blood work were performed by Dr. X. They were not; I had never interacted with that doctor.
She also told me that the blood work was processed by another doctor. But this should’ve been processed by a lab tech and billed as such.
After 20 minutes of this back and forth, she resolved that my claim would be processed for reconsideration and that I should hear back within 10 days.
I never heard back.
I proactively checked my claim status a few weeks later and found that I now owed just a little bit less money than last time. With no further explanation.
Frustrated, I called my insurer again and jumped through the same hoops of waiting and explaining my situation. I took several more punches and felt nearly out of willpower to resolve this issue.
One last effort. Still on the phone, I laid out every single point along my journey for this visit, from seeking a primary care provider via the insurer, to scheduling the visit, to exactly what was performed on-site and by whom. Then I asked the rep to contact the family office while I stayed on the line to verify what I had just explained to her. The rep put me on hold. Ten minutes later, the rep was back and explained that there seemed to have simply been some miscommunication and that she’d reprocess my claim and expected everything to be cleared up within 10 days.
Again, I didn’t hear back. But this time when I proactively checked my claim status, I was relieved to find that my amount owed was $0. Whew.
This experience — plus the annoyance of having to wait several weeks for the appointment to begin with, sitting in the lobby for 20 minutes beyond my scheduled time, filling out pages of paperwork, and all-around painful customer service — had me jaded.
Because really, something as simple as a wellness checkup shouldn’t be so burdensome.
My anecdote is an abnormal normality for almost every American. I can’t think of a peer that hasn’t had a frustrating healthcare experience.
As articulated by Elisabeth Rosenthal in her insightful book An American Sickness, we are all potential victims of medical extortion.
It’s no surprise that Americans are dropping out of healthcare unless absolutely mandatory.
According to a 2015 ZocDoc survey, 80% of Americans — and notably 93% of Millennials — delay or forego preventive care visits due to inconvenience. On top of that, 51% of Millennials haven’t seen a primary care provider at all in the last twelve months.
That’s why we built Statum Health, a web platform that lets users easily and conveniently schedule and receive primary care visits in their homes and offices with complete transparency. And that’s also why we created our own network of Nurse Practitioners who are trained and empowered to deliver the house calls with a focus on quality patient experience.
At Statum Health, we believe that primary care should maintain a standard of accessibility that doesn’t exist with the status quo today. Because accessible primary care is our best hope for bending the long-term healthcare cost curve.
No travel. No wait times. No hidden costs. A better patient experience.
We have deep empathy for this customer pain point. In a service sector as deeply personal as healthcare, we’re frustrated with the dysfunctional economics — where value stays the same or worsens each year and price continues to rise at unsustainable rates.
The good news is that there is a budding fleet of healthcare transformers like ourselves looking to challenge the status quo. And there are a growing number of trends in favor of innovative payment and delivery models to improve patient experience.
But we’re not here to simply take advantage of existing reimbursement models, and we’re certainly not here to sell features.
We’re here to bring value to the care continuum by offering a solution based on what people actually want — an easy, convenient way to receive quality in-person primary care wherever and whenever.
There are a lot of people who deserve this solution now, so our team is hard at work on our mission to improve community access to healthcare.
First stop, Philadelphia.
Statum Health is now serving house calls in Philadelphia. Check out www.statumhealth.com to learn more about what we’re up to.
This is why we launched an on-demand medical house call company in Philadelphia was originally published in Statum Health on Medium, where people are continuing the conversation by highlighting and responding to this story.