MDSave is all the RAVE in Healthcare
January 30, 2015
Updates below the original story
People don’t know what they don’t know and that’s never more evident, than when it comes to their healthcare plans. People don’t know what their deductible is or that their co-payment isn’t so their doctor can drive an expensive luxury car (a co-payment is a contract between the patient and their insurance company.)
*Updated: Patients: It’s illegal NOT to pay your co-payments. That’s a contract between you & your insurance company & NOT you and your doctor. Non-payment could result in your insurance company LEGALLY dropping YOU. It’s a RED FLAG if an office offers to waive your co-payment. The DOJ recovered $47 million from Health Diagnostics Laboratory (HDL) & $1.8 million from Singulex for illegal kickbacks by routinely waiving patient co-pays and deductibles. USDOJ
Did you know that offices that ‘waive’ the co-payment are committing fraud and your entire claim could legally be kicked out (example $100,000 surgery not paid for because the office opted not to take $25 co-payment)? You as the patient could be responsible for the entire amount as a result of a simple non-collection of a co-payment.
Or both you and your healthcare provider and their entire office could lose the entire contract with the insurance company all because of a $25 co-payment. Meaning you’d no longer be insured. Most patients also don’t know that if they’re insured it’s healthcare fraud to pay cash out-of-pocket for testing as a means to get around their high-cost deductible. Oh, it’s not the American public’s fault that these are little-known facts, the health insurance contracts are about as clear mud and Obamacare turning into Obamascare isn’t really helping issues.
And here are some current scary statistics regarding patient coverage:
3-5% of families meet their high-cost deductible annually
This means that most of us that we won’t hit our deductible. One way to go and save money (if you are relatively healthy) is to get catastrophic coverage. It offers lower monthly payments and will basically protect you from worst-case scenarios like serious accidents or illnesses.
More information: Catastrophic health insurance plans
For the first time in my life, I did not have insurance. I had open heart when I was 18 and no major trouble until I broke my leg three years ago. Catastrophic coverage is the ideal situation for me, provided I don’t fall off a 5-inch pair of Gucci’s anytime soon. I do also have a few visits to the doctor each year, but nothing that would add to up $3,500.
As a steadfast champion of reducing burdensome barriers and red tape, I was proud to sign a bill that does just that,” said Governor Ducey. “Whether in business or in health care, Arizonans deserve excellent, efficient and cost-effective service. This bill keeps regulations lean while protecting our doctors and health care providers and expanding opportunities for Arizonans to get the testing they need in a timely manner.
Ducey’s new plan is good in theory but lacks any real transparency which is always a red flag. I started looking for alternatives that would provide me with the best of both worlds (catastrophic and occasional coverage) for the best price. Enter, MDSave, a medical startup out of Tennessee, which offers full transparency via cash pay prices, without negating your current insurance, for all medical procedures in each city (eventually).
Let’s say, you hurt your hand and want to get a quick x-ray. Instead of calling 15 offices in your area and getting the run around of what it will cost you for a visit (most offices won’t provide that information over the phone), just go to MDSave. Type in what you need to be treated for (imaging) and where you live (AZ) and they list providers in your area the price for each visit type or procedure with 100% transparency.
Typically, your physician would bill your insurance company $175 for the office visit, but may only collect $55-$100, depending on their contract with your insurance company. Providers using MDSave, are ahead of the curve as they’re offering premium care and cutting out the middle man (insurance company) and passing the savings on to the patients. The price collected is comparable to what they’d get back from insurance, if not higher; and, the patient receives the same quality of healthcare.
Patients pay right there on the MDSave site, call and make their appointment(give the receptionist your paid voucher number) and no money changes hands when you go to the doctor. No co-payments, no bills, no prior authorizations, no uncertainty of costs, no mess. As a patient, you may pay $60 to see a doctor opposed to your co-payment of $25 but statistically, you weren’t going to meet your deductible ($3,000) so you put the money towards your health when you needed it. This also (check with your tax preparer) may be an allowable healthcare deduction on your taxes.
Whether you voted for President Obama or not is no longer relevant. The Affordable Care Act is great in theory but, umm well, the execution is where the scare comes into play. Also, the ACA does not address one of the biggest problems with healthcare, the insurance company.
As patients, it’s in our best interest to do a little research on our own and find what works for us. And, those of us who have worked in the private sector, if we had been in charge of executing the ACA website, we all would have been fired. That said, if we think we saw the last of the problems with the site, we’re just at the beginning.
Until we have patient #1 register (cycle 1), patient successfully sees a provider (cycle 2) and the provider receives payment (cycle 3), we are going to run into the same horrific problems at each cycle stage, as it stands now. It is not a matter of ‘if’ it is ‘when.’ As a consultant, who has consulted for IT and Healthcare, and in full disclosure for MDSave*, I always recommend a beta test in a few markets prior to a National roll-out.
And now is the time to take both sides (Republicans and Democrats) and bang their heads together in the center of the aisle to come up with solutions. I don’t care that the Republicans didn’t want the Act (and anyone Republican who runs on that platform vote them out of office.) And I don’t care if the Democrats want to blame the Republicans (and any Democrat who runs on that platform, vote them out of office). Both sides need to have accountability to all the American people, not just those who vote directly for them.
If you’re like me, and not too hopeful that egos will be set aside for the greater good of the American tax paying citizen, you’re starting to look for alternatives to offset healthcare costs. It’s imperative today that each patient become their own healthcare advocate (and women this is especially important for you) on everything from health insurance to what’s being prescribed to us, down to understanding how much your physician was paid by the pharmaceutical and med device companies under the Sunshine Act (or Open Payments).
Physicians and other Providers are initially hesitant to embrace such transparency of pricing for fear their competition will undercut them, their insurance carriers will cut their fee payments, or patients will view their services or talents as ‘discounted.’ All of which are false and unfounded fears. The landscape of medicine is changing, positively for patients, and providers not willing to adapt to the new transparency model will find their waiting rooms empty and their patients waiting to see a provider who is transparent with pricing. MDSave is rolling out in several markets now, and if you don’t see your doctor on the list, you may want to ask them why.
Updated: April 4, 2016
Not always, but often enough to raise a red flag, venture capital funded startups utilize:
False projections + Hypergrowth = Overvaluation = Fraud
I’m a venture capital funded startup fraud whistleblower, 13 years in the healthcare/startup industry (sales, marketing, development), for the last 4 years, privately consulting. I was paid by MDSave in (2013) and I no longer consult for MDSave.