By Jason Delimitros, Vice President, Insurance Operations, Sidecar Health
It’s clear we need innovative options for health insurance. More than 70 percent of U.S. adults report the current healthcare system is failing to meet their needs, medical debt is the leading cause of personal bankruptcy, and employers are facing spiraling healthcare costs each year.
Working in the health insurance industry for over 20 years, I am not surprised that consumers continue to experience confusing network restrictions, high out-of-pocket costs and difficulty accessing care. The quality of care and medical innovation within the U.S. is top notch, but the health insurance system continues to be restrictive to providers and expensive for consumers. As a result, many people delay or go without the care they so desperately need.
Sidecar Health is providing innovative solutions to this problem in three ways:
- Transparency of healthcare service costs and covered benefits, ensuring there is an option with no balance bills for members.
- Benefits are available at point of sale with the Sidecar Health debit card, ensuring providers are paid immediately and often offering better pricing to Sidecar Health members as a result.
- No restrictive networks. Healthcare benefits are available at any licensed medical provider.
Our members choose care knowing what their plan will pay in benefits as well as cash prices charged by local healthcare providers. This is in stark contrast to a network-based model where patients typically don’t know the actual price of health services. Too often, consumers receive balance bills from providers after insurance reimbursement has been applied, with little transparency or opportunity to change the outcome. Sidecar Health provides unprecedented transparency that empowers our members with tools and information to make informed healthcare purchase decisions.
The Sidecar Health proprietary member portal offers members information to understand their benefits and compare them with provider prices. Prices can vary significantly for the same service or medication. For example, a prescription can cost $10 or as much as $70 for the same medication. Our members pay for care with their Sidecar Health debit card, and the provider gets paid immediately. Cash pay pricing is typically more affordable, with studies showing it can be as much as 40 percent less than commercially negotiated rates.
Sidecar Health does not have prior authorization or complicated processes like step therapy. By reducing these restrictions, members get access to care in a timelier manner. Doctors don’t want to have their medical decisions second-guessed by insurance companies, so Sidecar Health has removed that onerous step.
Restrictive networks have had a profound impact on patients seeking mental health services. Struggling to find a provider can often lead to small issues escalating to bigger ones. This is especially true for children. A recent JAMA study showed that “the proportion of pediatric ER visits for mental health reasons has approximately doubled, including a 5-fold increase in suicide-related visits.” By removing traditional network restrictions, Sidecar Health members can access mental healthcare at any licensed mental health provider – some for the first time – and with the peace of mind knowing it is covered.
I can sympathize with potential skeptics who do not believe there is an alternative to our current health insurance system, but the data speaks volumes. It has challenged me to re-think how we enable quality, affordable, healthcare in the U.S. Sidecar is a growing presence in markets across the country, encouraging employers from every major industry to help their employees take control of their health. We’re rewiring health insurance to strip away complicated restrictions and add much-needed (and consumer-demanded) price transparency. The resulting coverage puts consumers in the driver’s seat of their care, at long last.
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