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I met Betty Heiman when she pitched her start-up, Transparent Healthcare, at the December meeting of Mid-Atlantic Diamond Ventures. She was one of a few entrepreneurs selected through a competition to appear on stage that day. She rocked! I couldn’t wait to introduce her to Disruptive Women readers and was pleased when she agreed to find some time in her busy schedule for this interview.

Betty, I’ve heard your pitch. I’ve also been to your website and want to encourage our DW readers to visit. Before they do, please tell them what you at MADV a few weeks ago about Transparent Healthcare. 

Health care in this country runs on a system of contracts and negotiations.  If you are not participating as a fully insured person, the rules and prices change dramatically. I have seen too many patients walk into medical offices, lean over the front desk, and with their backs to a waiting room full of people meekly whisper to the receptionist “I don’t have insurance, can you help me out?”

What they don’t know is they’ll typically be charged 2-3x the price contracted by the insurance industry and Medicare/Medicaid. To make matters worse, retail pricing for healthcare is difficult to determine and can drastically change location by location. Witness the experience of a 9th grader in the Philadelphia are and her publication in a medical journal.

Why should we care? 30 million reasons, that’s why. The Affordable Care Act is expected to leave 30 million people uninsured after full implementation in 2017. Who are they? Medicaid expansion will absorb many of those with the lowest income. The new face of the uninsured will be the working middle class – those who earn too much high to get subsidies on exchanges yet earn too little to afford the cost of insurance premiums, high deductibles and copays.  In addition, the young and healthy are opting-out of health insurance as rates have increased – a by-product of the ACA.  The undocumented in this country will also continue to be uninsured. These are the new faces of the uninsured. They are the 30 million who will continue to be charged hidden, variable rates for healthcare. Until now.

http://eventcompletehosting.com/orwc/cache/com_zoo/images/BettyHeiman-small_0f8220e0e9c924854eb10f6e7b07b18e.png

Betty Heiman

Transparent Healthcare created a new cash model for health care.  Transparent Healthcare is not health insurance – it is access to affordable care. We built a private medical network by contracting with providers to offer cash-paying patients care at a rate based on the Medicare fee schedule. Our contracted rates are fixed and public. That means that every cardiologist in Manhattan accepts the same rate for the same procedure – and our members know that price they must pay before they go to the doctor’s office.

Our customer service delivers concierge care for the uninsured and the underinsured.  We find a participating provider, make the appointment and translate the cost of care for our members. Transparent Healthcare benefits go beyond those delivered in primary care and include medical specialists, laboratory, radiology and other ancillary services. We assure the same price transparency and negotiated rates for dental care and pharmacy dispensing as well. With Transparent Healthcare, the consumer never pays retail again!

And, we offer benefits that go beyond pricing. Board certified physicians are just a phone call away with our telemedicine service, which operates day and night. These physicians consult, diagnose and even prescribe medication when appropriate. Our members avoid the high cost of emergency room and urgent care visits when they use this service.

Transparent Healthcare has created a new platform for access to care that is affordable – even when health insurance premiums, deductibles and co-pays are not.

How have providers responded? Isn’t the fee you’re offering them just another version of a discount?

This is not a discount for the uninsured. It is a contracted rate, similar to the reimbursement rate that providers receive from insurers and the federal government. Our members pay cash at the time of service, eliminating the cost and burden of billing and collection by the physician’s office. Physicians like that. In fact, many physicians tell us that they need the price transparency that Transparent Healthcare brings to their practice.  Their own patient population was insured yesterday – but uninsured today. Transparent Healthcare gives physicians the opportunity to talk about the price of care – not only in their own office, but across the whole spectrum of care, including specialists, radiology, labs, and pharmacy.

I believe what you’re saying, but really, Transparent Healthcare sounds a bit too good to be true. I know it’s not insurance in the usual sense, but what you offer in care for the price….really, it seems too good to be true. I have insurance but I’m ready to sign up. Given that I’m healthy, might Transparent Healthcare be the antidote to unaffordable deductibles and copays?  

It’s true – and it’s time for the health care consumer to rise up and learn how to control their costs – in terms of time and money!  Transparent Healthcare works for both the uninsured and those who are insured with healthcare plans with high deductibles and high co-pays.

The telemedicine feature is a great way to contain costs and is a tremendous time saver!  I have used telemedicine while traveling out of state and, as a Mom I also appreciated telemedicine when I did not have to take my kids to the pediatrician or to the emergency room during the night when they were sick. In both instances, I saved the expense of my copay and saved hours of my time. Had I been uninsured, the savings to me would have been even greater, as I would have otherwise had to pay the full cost of these visits.

Employers are discontinuing dental and vision insurance, right? Transparent Healthcare brings significant savings directly to the consumer. Chances are, if you are paying cash for your healthcare needs – you are paying too much!

What’s next? Imagine it’s a year from now in 2015, what do you want to see for Transparent Health Care? Is this a model? Are you ready to take-on the rest of the country?

As health care reform matures in the marketplace, a new model for healthcare will form to complement the traditional insurance offerings we see today. Transparent Healthcare works to broaden the narrow networks that we are finding on the exchanges and allows for affordability and price transparency when seeking out-of-network care.  The cash model for health care that we built will also act as a platform for catastrophic insurance and ancillary insurance products that can be combined to satisfy the needs for all health care consumers. We are off and running in the NY/NJ metro markets and poised to launch in key markets across the country.  Everyone needs to be a knowledgeable health care consumer.  With Transparent Healthcare – they can be!

Many DW readers are policymakers and those who influential them. Are there any laws or regulations at State or Federal levels that make it harder for Transparent Health Care to be the innovative solution you are?

I’m not sure we have room for that discussion here!!! If anyone is interested, though, I’d love to talk more.

Thanks Betty, I look forward to watching Transparent Healthcare take off!

 

 

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353 Responses to “Transparent Health Care: Finally!”

  1. Marcia Nusgart Says:

    This is a fabulous idea and am anxious to hear how it takes off in the New York/New Jersey metro area. Since so much of wound care is treated in the home, the telemedicine part of this is very important. Great to hear about this new business!

  2. Casey Quinlan Says:

    Sounds like a promising option, but speaking as someone who has one of the high-deductible plans mentioned in the post, I know that any $$ spent out of network on my plan counts zip-zilch-nada toward my eye-wateringly high annual deductible. How can someone determine, before joining, if the doctors in any given insurance plan are within the TransparentHealthCare provider list?

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    The telemedicine component of Transparent Health must be getting a workout with all the recent bad weather on the east coast!

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