HealthJoy Funding Announcement

HealthJoy Funding Announcement

We have some exciting news to share!

I’m very pleased to announce that we have raised over $3 million in funding led by GoHealth and an amazing group of angel investors. This investment will allow us to continue to work hard on our healthcare decision platform and advance the development of JOY, our human supported machine intelligence, that is already helping thousands of people every day.   The initial response from our users to JOY has been astounding and we look forward to continually developing her to become smarter and deal with more complex healthcare situations everyday.

Update: Read about our $6 Series A funding and $12.5 Series B funding rounds at Built in Chicago.

HealthJoy was created in 2014 to help people make smarter healthcare decisions and in that time we have been involved in the lives of tens of thousands of people to make that happen.  We spent much of these first two years developing a deep understanding of the healthcare marketplace and the criterion to reach optimized care decisions.  This year is shaping to become a pivotal year for us as we have launched our machine intelligence to not only learn from our own conversations, but drive a more individualized, localized experience for our members.

Our mission is for people from all walks of life to live happier and healthier lives and we are confident our technology platform can deliver amazing results to anyone in the world.

We would love for you all to be part of our launch!

The Rise of Out-of-Pocket Medical Expenses

The Rise of Out-of-Pocket Medical Expenses

Over the last decade, medical expenses have skyrocketed. To keep up with expenses and maintain affordable premiums, health insurance carriers have been forced to create coverage options where the consumer can choose to take on additional risk in the form of higher deductibles, copays, and maximum out-of-pocket expenses.

Out-of-pocket expenses are those expenses that the insurance plan doesn’t cover. Depending on the type of insurance plan you purchase, you probably have a deductible and a coinsurance level of payment. When you have a medical claim, the deductible is applied first. This is an out-of-pocket expense payable by you. After the deductible, the insurance company and the insured share a percentage of a certain amount of the claim—called coinsurance—before the insurance company pays the rest of the claim.

Under the Affordable Care Act, which was passed into law in 2010, health plans must now all fall into a four-tier system: platinum, gold, silver, and bronze. The higher the tier, the richer the benefits and the higher the premiums paid for these benefits. Two important factors when choosing a health insurance plan are the monthly premium and the out-of-pocket maximum.

Looking for a catastrophic plan to cover major medical expenses and keep premiums at an affordable level, many take their chances by enrolling in a basic bronze plan, which offers the cheapest premium but has the highest out-of-pocket expense for the insured. If they remain healthy, this plan will save them money. Unfortunately, when a health issue arises, so does the threat of mounting medical bills. Depending on the health issue, the amount owed by the insured can reach into the thousands of dollars. For those on a fixed income and not prepared to meet the financial responsibility, the outcome can be devastating.

With the possibility of this medical debt looming in the distance, some may choose to forgo necessary medical treatment and medications because they can’t afford to pay for them. Still others that cannot go without treatment are being forced to make decisions on how they will pay for the medical treatment they need while still meeting the rest of their monthly living expenses.

If serious injury or illness does strike, and you find yourself facing a mountain of medical bills, don’t panic. Yes, you are responsible for the charges, and you will eventually need to pay them. But there are a few things you can and should do first to make sure that you are only paying what is necessary.

  • Review the entire bill – Although there will probably be charges listed that you don’t understand, you will want to make sure you are only being charged for services and supplies that were provided to you. If something looks incorrect or doesn’t make sense, contact the hospital’s business office and ask for an explanation. Errors are much more common than you would expect. If it is determined that an error was made, an adjusted bill should be provided. In some cases, if you report the error to your insurance company, they may give you a monetary reward for helping to reduce the amount of the overall claim. You can also submit any bill above $1,000 for free to HealthJoy to review. If we find an issue, we can even negotiate on your behalf.
  • Set up a payment plan – Hospitals want to get paid, so they will work with you to set up monthly payments toward the total bill until it is paid off. Generally, there will be a small monthly finance fee involved, but this will allow you to set up payments that you can afford.
  • Negotiate the total amount owed – If you do have a lump sum of money set aside for medical expenses but not enough to pay the entire bill, you may want to ask the hospital if they would be willing to negotiate the total amount of the bill. Setting up financing and monthly billing is an extra expense for the hospital, and if you can pay one large portion of the bill at one time, they may be willing to accept this as full payment.
  • Seek out financial assistance – If you are unable to either pay one lump sum or make monthly payments fit into your budget, there are other resources that you can turn to for help. Charitable organizations, such as churches and non-profits, may be able to assist you. You may qualify for assistance based on your income by contacting your state human services offices listed on the following website: https://aphsa.org/

Facing financial challenges brought on by excessive medical expenses can be frightening. It’s important to keep a level head and search for options, solutions, and help if needed. The only thing you cannot do is nothing. Ignoring the bills will only make the situation worse. Make a plan and focus on working to pay down the debt as you are able.

HMO vs PPO – Which is Better?

HMO vs PPO – Which is Better?

Selecting the best health plan option for you and your family can be a confusing task if you are unfamiliar with or don’t understand the ins and outs of the different plans being offered.  Although most insurance carriers must provide certain benefits on all of the plans they offer, individual benefits and how they are administered can differ so it’s important to learn the differences.

HMO vs PPO

Two of the most popular types of health plans are HMOs and PPOs.  Overall, the benefit structures offered for both plan types are similar but each also has specific limitations and requirements that the member must follow.  If the requirements aren’t followed there may be a lack of coverage or benefits may be paid differently than expected.

HMOs and PPOs are similar in that they both rely on using a preselected network, or group of doctors, to provide care to their members.  To receive the highest quality and most efficient health care the member must use doctors in the network.  Using doctors outside of the network may result in reduced benefits or no benefits at all.  The most significant difference between HMOs and PPOs is the way that care is administered.

A health maintenance organization, also known as an HMO, is the more restrictive of the two types of plans.  While both utilize a network of doctors to provide care, the HMO requires the member to select a primary care physician (PCP) to manage all of their health care.  The thought behind this process is that a primary care physician knows their patient and is the best to address their medical needs while still managing costs.

The HMO philosophy places the decision making authority for all care in the hands of the primary care physician. This means that when a health condition is discovered, the doctor is responsible for determining the course of care.  The patient must be referred by the primary care physician before seeing another physician, such as a specialist.  This can be frustrating for people who want to have the freedom to choose their own care.  If a patient chooses to see a doctor to whom they were not referred, there generally will not be any coverage and the patient will be responsible for all costs.

For members looking for a little more control over their own health care, a preferred provider organization, or PPO, may be a better option.  Generally, the premium for this type of plan will be a little higher than a HMO because it is less restrictive and allows the member to have more flexibility and decision making in their care options.

A PPO does not require a member to select a primary care physician.  However, they are required to choose physicians that participate in the selected network.  No referral is needed to see a specialist or get a second opinion.  As long as the doctor is in the network they are eligible on the plan.  Unlike a HMO, there are generally benefits for those that choose to see a doctor outside of the network. But, they should expect to pay more of the out of pocket cost themselves since they choose to go outside the network.

So HMO vs PPO, which is better? it really comes down to price and physician access.  Those willing to accept a more restrictive system where the doctor steers the care based on cost effective measures to lower premiums may find a HMO is the answer.  Those looking for wider access and patient choice would benefit from a PPO.

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<div class='gf_browser_unknown gform_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_9' > <div class='gform_heading'> <h3 class="gform_title">10 Benefits Presentation Tips from TED Talks eBook - 2-Col (Pop-up)</h3> <span class='gform_description'></span> </div><form method='post' enctype='multipart/form-data' id='gform_9' action='/blog/2016/03/' > <div class='gform_body gform-body'><ul id='gform_fields_9' class='gform_fields top_label form_sublabel_below description_below'><li id="field_9_8" class="gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_8' >First Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_9_8' type='text' value='' class='large' placeholder='First Name' aria-required="true" aria-invalid="false" /> </div></li><li id="field_9_9" class="gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_9' >Last Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_9_9' type='text' value='' class='medium' placeholder='Last Name' aria-required="true" aria-invalid="false" /> </div></li><li id="field_9_4" class="gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_4' >Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_4' id='input_9_4' type='text' value='' class='medium' placeholder='Email' aria-required="true" aria-invalid="false" /> </div></li><li id="field_9_5" class="gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_5' >Company name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_9_5' type='text' value='' class='medium' placeholder='Company name' aria-required="true" aria-invalid="false" /> </div></li><li id="field_9_10" class="gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_10' >Company Size<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_select'><select name='input_10' id='input_9_10' class='large gfield_select' aria-required="true" aria-invalid="false" ><option value='' selected='selected' class='gf_placeholder'>Company Size</option><option value='1-100' >1-100</option><option value='100-500' >100-500</option><option value='500-3000' >500-3000</option><option value='3000-1000' >3000-1000</option><option value='10000+' >10000+</option></select></div></li><li id="field_9_7" class="gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_7' >What Describes You?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_select'><select name='input_7' id='input_9_7' class='large gfield_select' aria-required="true" aria-invalid="false" ><option value='' selected='selected' class='gf_placeholder'>What Describes You?</option><option value='Employer' >Employer</option><option value='Benefit Consultant' >Benefit Consultant</option><option value='TPA' >TPA</option><option value='PEO' >PEO</option><option value='Other' >Other</option></select></div></li></ul></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_9' class='gform_button button' value='Get Your eBook' onclick='if(window["gf_submitting_9"]){return false;} window["gf_submitting_9"]=true; ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_9"]){return false;} window["gf_submitting_9"]=true; jQuery("#gform_9").trigger("submit",[true]); }' /> <input type='hidden' class='gform_hidden' name='is_submit_9' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='9' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_9' value='WyJbXSIsImFkODg5MTk3ZmY1MDIyZGVjZjEyNWI2ODk1Y2YyMGZiIl0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_9' id='gform_target_page_number_9' value='0' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_9' id='gform_source_page_number_9' value='1' /> <input type='hidden' name='gform_field_values' value='' /> </div> </form> </div>