Solving the Healthcare Math Problem

Jul 02, 2018
Eligibility, Solutions, Videos 0 Comments

This week Eric Anderson, Clearwave COO, will be discussing how Clearwave assists patients and healthcare providers by helping calculate the estimated patient responsibility. Mr. Anderson solves for the viewer what he calls “the Healthcare Math Problem.” By communicating directly with health insurance companies, in seconds Clearwave Corporation is able to provide on the front end information which previously required manual phone calls between the provider and the insurance company.

Transcript:

Today I'm going to discuss how Clearwave helped solve what I like to call the healthcare math problem. If you or I would walk into Home Depot to buy a hammer, what you would pay, and what I would pay would be the exact same price, and it would be easy for us to figure out what that price is because it says on the shelf how much the hammer costed. Anybody that walks in pays that price for the hammer. But in healthcare, it's a lot more complicated.

In healthcare it depends what provider are you going to see, what insurance do you have, what's your benefit profile, and all of these things enter into the mix. And so, the same two people getting the same service can pay vastly different rates. And this is a challenge for hospitals and clinics because they need to know what is the patient responsibility going to be. So, today I'm gonna show you how Clearwave helped solve that problem, and I'm gonna use my own personal experience.

About six years ago when I was 42, I had a little bit of a midlife crisis and I decided I would take up mountain biking. And I'd been doing it for about six months, and I kind of got the idea that I was pretty good at it, and I was pretty skilled. And so I went to one of the most difficult bike tracks in mountain biking tracks in Georgia called the Monster Mile. And it's only a mile long, but I wrecked probably a dozen times and that landed me in front of my orthopedic surgeon who sent me off to get an MRI. So, I'm gonna use that example for how we solve the healthcare math problem.

So, I have United Healthcare and I went to Northside Imaging to get my MRI. So, the first number you need to know is, what is the contractive rate that United Healthcare has with Northside Imaging? And the contractive rate is the amount of money that Northside Imaging is allowed to charge me as a United Healthcare member. So, the contracted rate was $937.50. So, that's the amount of money that Northside Imaging is allowed to charge me. 

But the second thing you need to know is, what is my coinsurance? And coinsurance is the percentage that you pay of any benefit that your insurance company pays. My coinsurance is 10%. The third thing that you need to know is, what is your remaining deductible? My remaining deductible was $500.  Now, there's one final thing you need to know, and that is what is your copay. My copay for an MRI is zero dollars.

So, now we have all of the numbers we need to solve the healthcare math problem. My remaining deductible, $500, I have to pay that which means United Healthcare is gonna pay everything over the deductible, in this case, $437.50. My responsibility is 10% of that number. So, I'm gonna pay $43.75. So, if I take $43.75 plus my deductible, I end up with the solution to the healthcare math problem, which is my MRI is gonna cost me $543.75, which the way that Clearwave helps, is that we provide automatically the coinsurance, the remaining deductible and the copay so that providers can solve this problem. And I will just mention that $543.75 was only about $150 less than the mountain bike cost me. Thank you.