What are all the qualms with the health insurance industry? I’m joining an insurance startup and plan to explore the context

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No visibility into prices, coverages defined vaguely, difficulty in determining coverages. For example, my plan (not KPMGs but spouses plan), I get my blood drawn as part of yearly checkup from my doctors office which the office visit is covered Using the same doctors office which is covered by insurance fully = blood work not covered and I pay 300 for the lab work. Getting a prescription for blood to be drawn on a different day, in a different location where I need to call the separate provider to get an appointment = covered fully Only found this out that blood work wasn’t “preventative” after I got hit with the bill.

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Thanks for sharing!

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I’d say lack of a true focus on patient experience, because usually the patient is not the customer. Also medical policy is not perfect. In some cases it works to limit unnecessary costs, in other cases it puts undue burden on patients and physicians

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Who u joining?

Will let you know if you respond to the post :)

Adding some to get it going: 1. Patients -difficulty understanding benefit plans and coverage -archaic communication pathways with insurance reps when questions arise -claim denials for OON billing -claim denials in general 2. Providers -claim denials in general -prior authorization -if not in network in rural areas, it’s very hard to stay afloat and compete financially -if not in network in urban/suburban areas, the patient panel depends on the success of whichever insurer is accepted

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