Health Insurance Shopping & Innovation – Tech Zone with Paul Amadeus Lane

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

Paul Amadeus Lane, host of Tech Zone on ABC News Radio (1490 AM KMET), digs into health insurance, technology and open enrollment with Michael Levin, CEO and Co-Founder of Vericred.

In this segment of the show, Paul and Michael talk about the need for choice and transparency in health plans. Michael walks listeners though some of the challenges that come when navigating open enrollment and discusses different ways that Vericred’s technology enables health tech companies to deliver a better health insurance shopping experience to both companies and consumers.

What should today’s health insurance shopping experience be?

“Shopping for health insurance should be simple. Enter your doctors, enter the drugs you take, enter any life conditions (pregnant, asthma, etc) and have recommendations delivered to you with plans that fit you and your life.” – Michael Levin

Click below to watch the full segment and hear tips on how to save this open enrollment.

The Challenge of Comparing Medication Cost and Coverage May Soon be Solved.

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

As prescription drug costs continue to climb, it’s no secret that patients today are hit with more out-of-pocket costs for the drugs they use. While health organizations are slowly shifting and empowering patients to take control of their own healthcare, finding the facts about which drugs are covered under which plans, and how much you will pay, can be a time consuming nightmare. The first step in simplifying this process for consumers is to provide transparency.

Addressing the issue head on, the Robert Wood Johnson Foundation recently kicked off their latest challenge dedicated to the coverage and cost of prescription drugs. At the same time, Vericred has just released formulary datasets for the individual under 65, small group and large group health insurance markets. You can read more details about our formulary datasets here. Working in collaboration with the Robert Wood Johnson Foundation, the team at Vericred is making our formulary API available to all Rx Cost and Coverage Challenge entrants at no cost for the purpose of the challenge.

According to Katherine Hempstead, senior advisor at the Robert Wood Johnson Foundation, “Access to and affordability of prescription drugs are extremely important elements of plan choice for many consumers, particularly for those who may suffer from chronic conditions.” Read Katherine’s full post from last week on The Health Care Blog. Through the Rx Cost and Coverage challenge, the Robert Wood Johnson Foundation is hoping to find a solution that addresses prescription drug access and affordability.

If you’re a developer and have what it takes, we urge you to learn more about the Rx Cost and Coverage Challenge. You can read more details about the background of the challenge here. This is a big opportunity to be involved in developing a potentially – make that hopefully –game-changing solution that puts knowledge at the fingertips of consumers around the nation.

First round submissions are due August 14, 2016, and the winners will be featured at the Health 2.0 Conference, not to mention $100,000 in cash awards. We wish you luck and can’t wait to see what you create!

Avoiding a Costly Out-of-Network Experience

The other day, I was in the car when I heard a commercial for a bariatric clinic offering lap-band surgery.  The commercial ended with these words: “…your PPO insurance should pay.”   This might lead someone to believe that their insurance would cover the entire procedure.  It.  Does.  Not.

This is by no means the only statement that may, purposely or not, mislead a consumer. The financial consequences of seeing an out-of-network provider are profound.  Absent some kind of negotiation, you’ll be responsible for the “list price” of any medical care you receive.  If your insurance plan is a PPO or a POS (a plan with out-of-network benefits), you’ll be billed for the difference between a procedure’s list price, and the amount allowed under your health plan.  That allowed amount may be a fraction of the list price, and you’re on the hook for the remainder.  This is called balance billing.  And if you have an EPO or HMO that limits you to in-network providers, you’ll be responsible for the full list price of any service rendered by an out-of-network provider.

The problem’s made worse because some healthcare providers play a little fast and loose with the terms.  A doctor who says they “accept” or “take” a plan, may simply be saying that they will bill the plan.  You’ll be responsible for any balance due.

So what do you do?  First, make sure your provider is in-network.  You can check with your insurance carrier or on your plan’s doctor search site.  But be careful. Your insurance carrier may offer many plans and many networks.  Make sure your provider participates in your particular plan.

And when speaking with a provider, you have to be very specific about asking “are you an in-network provider in my health plan.”  This leaves little room for ambiguity.  It’s also recommended that you make sure that any ancillary services are performed by in-network providers.  Your annual physical, for example, may include a blood draw, EKG and lab work – all done by different providers even though everything was taken care of in the same physical office.  So make sure those providers are also in-network.

It’s the only way to avoid having a costly out-of-network experience.