Yeah, to fix it would mean giving the insurance back the money on whatever was wrong.
The whole system is a mess. I had a bill rejected by the insurance as a duplicate. No, but I could easily see why they thought it was--and they told me how it should be billed so it wouldn't be rejected. Call the lab, tell them what they did wrong in the billing. They resubmit unchanged. The insurance won't accept my statement that it's legit. Call the lab, simply offer to pay it at the negotiated rate (which is all I was after, the deductible wasn't met.) Round and round--finally the insurance rejects it as billed too late and the whole thing goes away.
Is there a chance for a HN starter upper to "fix" some of this (or at least a service to tell you what to do), or is it just too spaghetti like? Not from the US so haven't experienced it.
The same thing that's keeping the biller from doing it correctly will also keep the startup from fixing it.
Unless you intend it to be a manual process, which isn't practical since you'll need info from everyone that's going to be hard to collect, i.e. the same problem the biller has.
The way it used to work was the biller charged insurance, and insurance paid, and that was the end of it. No one ever double checked anything.
Obama (with Obamacare) changed that - now everyone has a high deductible, insurance pays part, but you pay part. And suddenly people are motivated to check the bills.
Realistically the biller just drops bills where the person has to pay, and they live off of what insurance pays automatically.
The "on paper" of what American health care is, vs the reality are very different. The reality is weirder, but better (by better I mean less expensive than it looks on paper).
