We can’t. When a doctor takes insurance, they must only do things approved by insurers. Insurers love predictability and avoid covering anything new and different for 10-15 years.
We want you to be in control. You are in control when you pay a transparent, fixed cost directly to a provider to treat a health problem over time. This helps you avoid the “will this cost me $50 or $5,000” problem you have when you visit a traditional doctor who is incentivized to bill you and your employer as much as they can. This also helps you avoid your doctor sending you a letter saying “I’m sorry, I no longer take your insurance.”
When a doctor gets paid via an insurance company, they agree to get paid only for established, federally-defined billing codes that power health insurance in America.
There is typically a 10-15 year process to get a billing code approved. A billing code is something like:
- Office visit, initial visit
- Simple sutures for a laceration
Say there’s a new way to get things done, like an Episode of Care, where you primarily communicate with your doctor online with messages and photos via Sherpaa, throughout the 3 weeks it takes you to get through your skin infection. This kind of communication and problem-solving (more like an email thread than a 10 minute office visit) between you and your doctor has not been defined by insurers and therefore do not have billing codes. Insurers only speak “office visit.” So, there’s no way for doctors to get paid if there are no codes to use to bill your insurance company. That’s why office visits or urgent care visits keep happening, even if 70-80% of primary and urgent care issues never need an office visit.
Why don’t health insurers approve new billing codes for fancy new things?
Health insurance companies depend on predictability. Via data from all these billing codes, they predict next year’s expenses and adjust you and your employer’s premiums accordingly. If they do a good job predicting next year’s usage, they make a profit. Anything new, like an Episode of Care, is an unknown to them that may throw off their predictions. Since they report to their shareholders, they must avoid as many unknowns as possible. But there’s a far better way to solve your health problems! They don’t care. Insurers must actively avoid innovation to ensure profitability to their shareholders.
If insurance is not involved, you are in control of your situation.
You get to decide who you see and how you communicate and solve health problems with them. You don’t have to be told by a doctor “I need to see you in the office” when you know you both know what you need.
When you use your insurance, you are at the mercy of hospitals, doctors, and large companies negotiating on your behalf. It’s safe to assume they don’t really care much about whether or not you can afford to go on vacation with your family this year or pay that $5,000 bill for that ER visit. Nobody ever said “I really love my insurance company.” Rightly so, you are just a member number amongst millions of others.
You get to decide which doctor you want to see. It won’t be decided for you by your insurer. If your doctor no longer works with your insurance company, you have to find another doctor even if you’ve worked hard over the years to keep your care all in one place with one doctor.