Why it’s so hard to figure out how much healthcare will cost

A big reason why health insurance in the United States is so messed up is that costs are so difficult to figure out.

Patients fail to understand the financial implications of their copay, coinsurance, deductible, and total out-of-pocket costs. And healthcare providers must continually verify coverage and relay the information to their patients. What’s even worse is the coverage details might not be accurate or up-to-date. This mess leads to unexpected costs for the patient and rejected claims for the healthcare provider.

If a healthcare provider doesn’t check a patient’s coverage before each appointment, there is a chance they miss a change that may impact the amount the insurance company will pay for a procedure. Patients are usually liable for the unexpected costs if their policy changed before receiving coverage.

Small private practices don’t have the time or resources to spend hours on the phone with each insurance company. The provider may only verify a patient once instead of before each appointment and hope for the best. This often results in the inevitable claim rejection and the passing on of costs to the patient.

Large healthcare providers have the ability to mitigate these problems with their increasing economies of scale. They might have an entire department dedicated to insurance verification and billing. Small practices struggle to compete, leading to a less diverse marketplace for health services.

To help solve this problem and provide transparency for patients and independent healthcare providers, Evie and I created Hey Healthcare. Hey Healthcare enables private practices to instantly verify their patients’ insurance coverage in a HIPAA compliant app. Healthcare providers enter a few details to see their patients’ copay, coinsurance, deductible, and total out-of-pocket costs from hundreds of insurers.

This is just the beginning for Hey Healthcare. We hope to solve the many insurance issues private practices face and make health insurance less of a confusing mess.