Half of Your Health Insurance Premium is Wasted and How to Get It Back
Without affecting payment amounts to facilities or providers at all.
Download a Demonstration Slide Deck Here
In 2016 in the people of the United States spent $550 billion onhealth insurance. Of that, we
collectively received $290 billion back in benefits. That means that for every dollar your family
spent on health insurance, they only got back about 53 cents on the
That means that on average your health
insurance company either kept or wasted about 47% of the money you paid them.
So what do health insurance companies really do? On a macro scale, they accept claims and pay
benefits. It seems pretty simple:
request and response. Netflix has the same kind of system. You request a movie and if they have it, they
play it for you immediately. Netflix
buys the product of movie makers; insurance companies buy the product of
healthcare providers. Sure there are a
couple of differences. Your insurance
company doesn’t have a handy dandy little list of things that they cover on
your policy, and even if they did, they work on ICD codes, currently in version
10. So that means that in our Netflix example,
you would have to have a three inch thick book to translate the name of your
movie into this arcane code that Netflix would then understand. There are several other problems such as the
fact that your insurance company doesn’t provide every movie to every consumer,
but we’ll get to that in a minute. The entire
point is, that exactly like Netflix, your insurance company simply handles
How do we make health
insurance more like Netflix, then?
First, we provide a web (or smart device) interface for our movie
watchers, er, doctors, to look up procedures, see if they are covered and for
how much. Then, if they are, we deliver
the payment in real time, directly after the procedure is performed. We’ve eliminated the back and forth, the
calling, the verifying, the adjudication, the monkey motion that is the
difference between the 47% they waste and the 3% on average, they claim as
If Netflix can manage your data for about $10 per month, your insurance
company should be able to manage your data for about $10 per month.
We here at Sentia Health
aren’t like your bloggers and pundits, they speak and write far better than we
can, but we actually solve the problems we identify. Having identified this problem a couple of decades
ago and marveling at the arrogance of the insurance companies for mandating who
does what work and how much it all costs, we solved the problem.
Sentia Health provides
an Electronic Medical Records Management System (EMR) free of charge to
doctors. There are no hooks or catches,
it’s really free. We make our money by managing
the health insurance data for our patients.
We charge, as mentioned above, $10 per month for the privilege of managing
the patient’s data, plus the true cost of the health insurance risk, clearly
about 53% of traditional insurance. If
the patient doesn’t have our health insurance, the doctors can still use our system,
they just have to jump through the hoops of medical coders, adjudication, billing,
as outlined above, to use the traditional insurance company. If the patient is our client, we
can pay for procedures performed in near real time with no effort other than documenting the patient
There will be additional savings too. First, the average practitioner in private
practice spends about $30,000 per year on some kind of EMR. The average practitioner also spends about
$42,000 per year on compliance an efficacy reporting. All our reporting is done in real time and
automatically. They won’t have to hire
some accounting firm to count the beans, just click button, get report. The
billing department will shrink, if not go away.
The doctors will know what is covered and for how much, and since we
publish all this information to the internet and make it available to the
patient, he or she has the ability to know the cost of a procedure before it’s
performed, and pass all that savings on to you.
Instead of having one huge insurance company, we are
currently in negotiations with Capstone Associated to allow practices to provide their own insurance via a captive insurance
agency. This would allow the practice to
set its own pricing and completely obviate the need for these wasteful, greedy
bankers and their insurance companies.
Ideally, with reference pricing, maybe 125-150% of what Medicare will
pay, we can even curb the rising cost of the care itself, causing practices and
hospitals to streamline their own processes like we have for big insurance.
Just as important, are some the other facets of Sentia’s
Integrated health and wellness – We provide patients with a
portal that scientifically analyzes the annual (semiannual, quarterly) checkup
and prescribes patient education on how to live healthier, better, and longer.
Integrated Email – We give the patient the ability to
contact the doctor via SECURE email.
Self-scheduling – log in and see when your favorite
practitioner is available and schedule a time to meet.
Questionnaires – Practices have the ability to design,
assign and read questionnaires online. This
means you as the patient don’t sit in the waiting room with sick people filling
out reams of paperwork.
Reporting – Individual and Population Health Analysis: the
individual gets a printable report of his or her health as it was recorded on
the date of the health assessment.
Population Health reporting gives the practice the ability to see how
they are doing.
Compliance – as this product matures, we will be able to
differentiate between people who live a healthier lifestyle and those do not by
comparing the individual’s metrics against themselves over time. Those who make demonstrably better decisions
will pay lower premiums than those who do not, based on personal metrics. No
longer will you be asked to pay for the risk of a “Bunny” who sits on the sofa
and eats bon bons and watches soap operas all day and weighs 600 pounds.
Telemedicine – Coming soon, you will be able to meet with
your doctor via web conference.
We have demonstrated a way to cut about half from the cost
of health insurance. This is
accomplished by streamlining processes and cutting out waste. We believe this is the only way to accomplish
this lofty goal without completely revamping the way care is delivered in this
country and we hope you share our vision.
Download a Demonstration Slide Deck Here