S. ♪ ♪ ♪ ♪ MAYBE YOU, A FRIEND OR FAMILY MEMBER HAS SAID IT BEFORE.

HEALTHCARE, FOOD OR HEAT.

I CAN'T DO ALL THREE.

PLEASE JOIN US FOR THE NEXT STAY WITH US AS WE TALK WITH Mr. CHRISTOPHER BLAKELEY ABOUT NOVEL APPROACHES TO HELP WITH MEDICAL BILLS NEXT ON "KENTUCKY HEALTH."

"KENTUCKY HEALTH" IS FUNDED IN PART BY A GRANT FROM THE FOUNDATION FOR A HEALTHY KENTUCKY.

>> VIEWERS OF A CERTAIN AGE MAY REMEMBER COMEDIAN JACK BENNY WHO WAS FAMOUS FOR HIS LONG HESITATION WHEN ASKED BY A ROBBER: YOUR MONEY OR YOUR WIFE.

TODAY THE QUESTION FOR FAR TOO MANY OF US IS YOUR MONEY, OR OUR HEALTH.

THIS TIME IT IS NOT THE ROBBER ON THE STREET WHO THREATENS OUR FINANCIAL SECURITY.

RATHER IT IS THE HEALTHCARE SYSTEM.

A CONSEQUENCE OF THE HIGH COST OF HEALTHCARE, EVEN FOR THOSE WITH INSURANCE, IS DEFERRING OF ROUTINE PHYSICAL AND DENTAL CHECKUPS, THE INABILITY TO EXECUTE AND FOLLOW TREATMENT PLANTS, AND SOMETIMES CHOOSING TO DELAY SEEKING CARE UNTIL THE SYMPTOMS AND COURSE OF THE ILLNESS ARE ADVANCED AND/OR LIFE THREATENING.

WE SPEND MORE PER CAPITA ON HEALTHCARE THAN ANY OTHER COUNTRY IN THE WORLD.

BUT WE HAVE LITTLE TO SHOW FOR IT.

WHY WE ARE NOT GETTING THE RETURN THAT YOU WOULD EXPECT FOR OUR HEALTHCARE DOLLAR IS A TOPIC FOR ANOTHER SHOW.

TODAY, HOWEVER, I WANT US TO LOOK AT WHO IS PAYING FOR THIS CARE AND AT WHAT COST TO THE INDIVIDUAL AND THEIR FAMILIES?

RIGHT NOW HEALTHCARE COSTS ARE THE LEADING CAUSE OF BANKRUPTCY FOR AMERICAN FAMILIES.

IF YOU THOUGHT THAT THIS WAS A PROBLEM FOR THAT INDIVIDUAL, THEN YOU WOULD BE MISTAKEN.

THE IMPACT OF BANKRUPTCY CAN HAVE AN INELIGIBLE DELETERIOUS IMPACT NOT ONLY ON THE CURRENT FAMILY MEMBERS BUT ON GENERATIONS TO COME.

TALK TO US ABOUT HEALTHCARE FAN FINANCING AND WAYS TO MAKE A PAYMENT SYSTEM MORE EQUITABLE FOR PATIENTS, PROVIDERS AND HOSPITALS, WE HAVE AS OUR GUEST Mr. CHRISTOPHER BLAKELEY.

Mr. BLAKELEY IS FOUNDER AND CHIEF OPERATING OFFICER OF REPATIENT, FOUNDED IN 2020 AND DEVELOPS NOVEL SOLUTIONS TO RESOLVE THOSE FINANCIAL CHALLENGES RELATED TO HEALTHCARE COSTS FACED BY LOW TO MODERATE INCOME COMMUNITY IS AND SMALL BUSINESSES.

Mr. BLAKELEY, CHRISTOPHER, THANKS FOR BEING WITH US TODAY.

>> THANK YOU FOR HAVING ME.

>> INTERESTING NAME.

REPATIENT.

HOW DID YOU DEVELOP THIS?

>> HONESTLY, WE USED A NAME GENERATOR ONLINE TO COME UP WITH A BUNCH OF DIFFERENT OPTIONS FOR US BASED ON WHAT OUR BUSINESS DID AND THEN WE LOOKED TO SEE WHICH OF THE URLS WERE AVAILABLE.

WE LIKED THE NAME.

THE URL WAS AVAILABLE AND IT SPOKE TO WHAT WE THINK THE SORT OF CORE MISSION OF THE COMPANY IS, WHICH IS AFFORDABILITY OF HEALTHCARE FOR PATIENTS.

>> TELL ME ABOUT THAT.

HOW DOES ONE SUGGEST SIT DOWN AND SAY I WANT TO MAKE HEALTHCARE AFFORDABLE FOR PEOPLE.

>> I HAVE TWO DAUGHTERS, 14 AND NOW 6.

BUT WHEN OUR SIX-YEAR-OLD WAS ABOUT A YEAR OLD, SHE GOT RSV, WE THOUGHT SHE JUST HAD A COLD.

TOOK HER TO THE DOCTOR'S OFFICE, 20 MINUTES LATER AFTER CHECKING HER OUT, THEY COME AND THEY SAY YOU ARE TAKING HER TO NORTON CHILDREN'S DOWNTOWN.

SHE IS IN TROUBLE.

SO SHE WAS IN THERE FOR SIX DAYS ON OXYGEN FOR FIVE.

GOT GREAT CARE.

SHE IS A GREAT KID.

PLAYS EVERY SPORT UNDER THE SUN.

YOU WOULD NEVER KNOW SHE HAD ANY ISSUES.

BUT AFTER THAT-- THE CARE WAS GREAT, THE BILLING AND FINANCIAL EXPERIENCE SUCKED.

IT WAS TERRIBLE.

WE HAD INSURANCE THROUGH AN EMPLOYER.

DEDUCTIBLE HEALTH PLAN, $2500 DEDUCTIBLE.

WE GOT THREE OR FOUR DIFFERENT BILLS FROM DIFFERENT ENTITIES.

WE DIDN'T KNOW, YOU KNOW, DO WE ADD ALL THESE TOGETHER?

IS THERE OVERLAP?

WE CALLED THE HOSPITAL, WE HAD AN HSA ACCOUNT.

WE DIDN'T WANT TO DEPLETE THE FUNDS.

WE ENDED UP OWING 2200 OR 2300.

DO YOU OFFER PAYMENT PLANTS.

WE DON'T DO THAT.

PAY WHAT YOU WANT EVER MONTH WHEN WE SEND YOU A BILL AND IT WILL BE FINE.

I SAID OKAY, THAT SOUNDS LIKE A TERRIBLE SOLUTION BUT IF THAT'S WHAT YOU SAY, WE DID THAT FOR A COUPLE OF MONTHS AND INEVITABLY WE GOT THE WHOLE BILL THAT SAYS THE WHOLE BALANCE IS GOING TO BE SENT TO SELECTIONS IF YOU DON'T PAY THE WHOLE THING.

SO WE HAD THE FINANCIAL FLEXIBILITY TO DO THAT BUT A LOT OF AMERICANS DON'T.

I JUST THOUGHT THAT'S A TERRIBLE SOLUTION.

THERE HAS GOT TO BE A BETTER WAY.

MY CO-FOUNDERS AND I TALKED ABOUT IT AND HERE WE ARE.

>> BASED UPON YOUR PERSONAL EXPERIENCE, IS THAT THE TYPICAL THING THAT LEADS INDIVIDUALS TO GOING INTO BANKRUPTCY WITH THEIR HEALTH PLANS?

>> YEAH, TWO-THIRDS OF PERSONAL BANKRUPTCIES ARE TIED TO MEDICAL DEBT.

SO, YOU KNOW, THE AVERAGE PREMIUM FOR AN EMPLOYER-BASED HEALTH INSURANCE PLAN FOR AN INDIVIDUAL THIS YEAR IS A LITTLE OVER $8,000.

IT'S $23,000 FOR A FAMILY.

SO YOU ARE PAYING THAT WHETHER YOU USE YOUR HEALTH INSURANCE OR NOT.

AND THEN YOU'VE GOT A DEDUCTIBLE THAT, ON AVERAGE, THE AVERAGE DEDUCTIBLE, INCLUDING MARKETPLACE PLANS IS 1700 FOR EMPLOYER BASED IT'S HIGHER.

IF YOU OPT INTO A HIGH DEDUCTIBLE HEALTH PLAN, COULD YOU HAVE A 3500 DEDUCTIBLE SO THE FIRST $3500 AFTER YOU HAVE PAID THE PREMIUM, THE FIRST $3500 IS ALL YOUR RESPONSIBILITY.

AND THEN YOU MOVE INTO YOUR CO-INSURANCE, WHICH IS USUALLY SOMEWHERE BETWEEN 70-30 AND 80-20 MEANING YOU COVER 20% OF THE NEXT COST UP TO YOUR OUT OF POCKET MAXIMUM MUM FOR AN INDIVIDUAL IS $9200.

FOR A FAMILY, IT'S $21,000.

SO YOU ARE PAYING 20% UP TO THAT MOINT.

AFTER YOU'VE MADE THAT PREMIUM AND YOU'VE PAID THE FIRST WHATEVER YOUR DEDUCTIBLE IS.

SO IF YOU HAVE A MEDICAL EMERGENCY, A MEDICAL PROCEDURE, YOU KNOW, WHETHER IT'S ELECTIVE OR YOU ARE BROUGHT IN AN AMBULANCE, YOU ARE ON THE HOOK FOR, UNLESS YOU'VE USED YOUR DEDUCTIBLE ALREADY, OVER 60% OF THE COST.

SO IF YOU HAVE INCURRED A 20 TORE 30,000 CHARGE, YOU ARE GOING TO HAVE A LARGE BILL COMING TO.

HALF THE COUNTRY DOESN'T HAVE 400 IN EMERGENCY SAVINGS.

HOW CAN YOU BE EXPECTED TO PAY AN 8 OR 9 OR $10,000 BILL IN 90 DAYS TO AVOID COLLECTIONS?

IN AN AFFORDABLE MANNER.

MOST PEOPLE CAN'T.

>> TELL ME THE SCENARIOS.

WHAT HAPPENS?

WHAT HAPPENS WITH THE BANKRUPTCY?

WHAT IS THE IMPACT TO THE FAMILY.

>> IF YOU LOOK AT BANKRUPTCIES, YOURY HIVE HIGH ESSENTIALLY YOUR CREDIT IS NON-EXISTENT AT THAT POINT.

YOU CAN'T GET A LOAN FOR ANYTHING.

AND IT STAYS ON YOUR CREDIT SCORE FOR SEVEN YEARS.

>> SEVEN YEARS.

FOR A PERSONAL BANKRUPTCY.

NOW THERE ARE STAGES OF THAT.

FOR THE FIRST 18 TO 24 MONTHS, YOU WILL NOT BE ABLE TO GET CREDIT ANYWHERE.

MAYBE A PAYDAY LOAN.

THAT'S ABOUT IT.

AFTER THAT, YOU CAN START TO GET ACCESS TO SOME CREDIT.

YOU MIGHT BE ABLE TO GET A HIGH INTEREST CREDIT CARD, A CARD BUY NOW FINANCE HERE KIND OF PLACES OR YOU ARE GOING TO PAY REALLY HIGH INTEREST RATES.

I WOULD NOT LOOK TO BUY A HOUSE OR ANYTHING WITH A BANK LOAN FOR FIVE TO SIX YEARS AFTER THAT.

SO, YOU CAN JUST THINK ABOUT ALL THE ADDITIONAL COSTS THAT YOUR FAMILY OR YOU AS AN INDIVIDUAL IS GOING TO OCCUR.

THAT IS GOING TO IMPACT YOUR FAMILY AND I AM FACT ON THE COMMUNITY, RIGHT?

CAR DEALERS, THEY'RE NOT GOING TO BE ABLE TO SELL YOU A CAR.

THAT'S ONE PERSON OFF THE LINE THAT CAN DO THAT.

REALTORS, AN IMPACT.

HOME SALES.

HOME REPAIR PLACES.

THAT STUFF TRICKLES OUT INTO THE BROADER ECONOMY, AND IT HAS A REAL NEGATIVE IMPACT FOR THE COMMUNITY.

>> WHAT IS THE IMPACT ON THE HEALTHCARE COMMUNITY?

HOSPITALS AND PHYSICIAN PRACTICES?

>> SO FOR HOSPITALS, HOSPITALS USUALLY ARE THE ONES THAT TAKE THE BRUNT OF THE DEDUCTIBLES.

MOST PHYSICIANS FIGURE OUT WE'LL WAIT FOR THE HOSPITAL TO BILL FIRST.

THEY'LL EAT UP THE DEDUCTIBLE, WE'LL COME BEHIND THEM AND THE DEDUCTIBLE IS MET AND GET PAID MORE FROM THE INSURANCE COMPANY.

SO THE HOSPITALS ARE TYPICALLY TAKING THE BRUNT OF THAT.

AND FROM THEIR PERSPECTIVE, ON AVERAGE, A HOSPITAL OF WHAT THE PATIENT OWES THEM, THEY ONLY COLLECT ABOUT 50 CENTS ON THE DOLLAR OF THAT.

50% AND IT CAN TAKE THEM UP TO TWO AND A HALF YEARS AS IT WINDS THROUGH THEIR OWN BILLING COMPANY, MOST OUTSOURCE THEIR BILLING AND THROUGH TRADITIONAL COLLECTIONS, THAT ATMOSPHERE, THAT'S FOR COMMERCIALLY INSURED FOLKS.

FOLKS THAT DON'T HAVE INSURANCE, WHICH THANKS TO THE AFFORDABLE CARE ACT, IS A SMALLER PORTION OF OUR POPULATION, BUT THEY'RE COLLECTING LESS THAN 10 CENTS ON THE DOLLAR WHAT THOSE PATIENTS OWE THEM.

THEY'RE ESSENTIALLY WRITING OFF MOST OF THE CARE WHICH THEN PUTS MORE OF A BURDEN ON THE HEALTH SYSTEM TO COLLECT FROM THE FOLKS THAT CAN AFFORD IT.

>> SINCE YOU MENTIONED THE AFFORDABLE CARE ACT, TELL ME A LITTLE BIT ABOUT SOME OF THE UNINTEND THE CONSEQUENCES THAT OCCUR WITH THE AFFORDABLE CARE ACT AND THEN I WANT TO TALK ABOUT SOME OF THE OTHER HEALTHCARE PLANS.

>> YEAH, I THINK THE MAIN-- FROM OUR PERSPECTIVE, THE MAIN UNINTENDED CONSEQUENCE, MAYBE IT WAS AN UNINTENDED CONSEQUENCE.

I THINK SOME DID INTEND IT.

YOU KNOW, WHEN YOU GO FROM-- WHEN INSURANCE COMPANIES WENT FROM A PLACE WHERE THEY COULD DENY YOU COVERAGE BASED ON UNDERWRITING, TO WE CAN'T DO THAT ANYMORE.

ANYONE WHO APPLIES FOR INSURANCE, WE HAVE TO GIVE IT TO THEM.

AS YOU CAN IMAGINE, AS A BUSINESS PERSON, THAT WOULD MAKE ME NERVOUS.

I DON'T KNOW WHAT THE NATURE OF THOSE FOLKS ARE.

IT'S SOLD THAT THEY'RE ALL GOING TO BE YOUNG AND HEALTHY, BUT WE DON'T KNOW.

IN THE NEGOTIATIONS, ONE OF THE THINGS THAT WAS PUT INTO THAT ACT AT THE VERY END BEFORE IT WAS PASSED WAS THE INSURANCE CARRIERS ESSENTIALLY NEGOTIATED THE ABILITY TO RAISE DEDUCTIBLES AND OUT OF POCKET MAXIMUMS EVERY YEAR.

AND THERE IS NO SUNSET PROVISION.

THERE IS NO LOOK BACK PROVISION.

THERE IS NOTHING THAT, YOU KNOW, AFTER FIVE OR 10 YEARS, WILL LOOK BACK TO SEE WAS THE IMPACT WHAT YOU EXPECTED?

IT'S JUST IN STATUTE AND IT IS IN PERPETUITY.

SO DEDUCTIBLES AND OUT OF POCKET MAXIMUMS ARE GOING TO GO UP EVERY YEAR.

ESSENTIALLY WHAT INSURERS DID WAS, THEY SAID WE'LL TRY TO HOLD PREMIUMS DOWN IF WE CAN.

BUT THEY'RE STILL PUSHING THE COST OF THE CARE ON TO THE PATIENT, THEIR MEMBERS BY FRONT LOADING THOSE DEDUCTIBLES AND INCREASING THE OUT OF POCKET MAXIMUM.

IEPTS DON'T LOOK AT THIS HAND BECAUSE THIS ONE IS STICKING...

TAKING THE MONEY OUT OF YOUR POCKET.

THE INSURERS ARE HAVING RECORD PROFITS ANNUALLY YEAR AFTER YEAR SINCE THE AFFORDABLE CARE ACT WAS ENACTED.

SO THEY'RE DOING GREAT.

THE SYSTEM IS WORKING FOR THEM.

>> SINCE THIS WAS PUT IN FOR INDIVIDUALS WHO ARE IN THE LOWER SOCIOECONOMIC GROUPS, THEY'RE REALLY BEING HIT WITH A BIG WHAMMY IN SOME CASES?

>> THAT'S RIGHT.

IF THEY'RE GETTING PLANS ON THE EXCHANGES, YOU KNOW, THOSE TIP THEIR, ESPECIALLY THE MORE AFFORDABLE ONES, THEY HAVE STRIPPED DOWN BENEFITS.

IT'S EFFECTIVELY A CATASTROPHE PLAN.

SO YOU ARE STILL PAYING A LOT MORE FOR THE COST OF YOUR CARE.

I THINK, WHILE IT DID GIVE THEM INSURANCE, IT PROBABLY, I THINK IT WAS INTENDED THE TO DEEP THEM OUT OF BANKRUPTCY BUT IT'S DRIVING THEM INTO BANKRUPTCY JUST AT A SLOWER PACE.

>> TELL ME ABOUT MANAGED MEDICAID AND MEDICARE.

>> HUMANA IS ELK IF I HAVELY A MEDICARE ADVANTAGE COMPANY NOW.

EFFECTIVELY AND THERE HAVE BEEN STORIES NOW THEIR HOSPITALS AND HEALTH SYSTEMS WILL NOT ACCEPT MANAGED CARAVANING PLANS.

>> WHAT ARE THE PLANS?

>> THEY'RE FOR FOLKS ON MEDICARE.

MEDICARE HAS PART A AND PART B, THE DOUGHNUT HOLY ESSENTIALLY.

SO, WHICH MEANS YOU ARE GOING TO BE ON THE HOOK FOR 20% OF I DON'T ARE COSTS IF YOU DON'T HAVE SOME SORT OF COMMERCIAL PLAN LAYING OVER YOUR MEDICARE THAT WILL HELP YOU PAY FOR SOME OF IT.

BUT YOU ARE GOING TO PAY A PREMIUM FOR THAT.

THERE ARE MEDICARE ADVANTAGE PLANS LAYER OVER AN EXTRA BENEFIT OF INSURANCE OVER MEDICARE AND THEN YOU, UNITED HUMANA, THEY'RE YOUR-- THEY MANAGE YOUR HEALTH INSURANCE LIKE THEY WOULD IF YOU HAD GOTTEN IT THROUGH YOUR EMPLOYER OR PENSION OR WHEREVER YOU'VE GOT YOUR AS SOON AS FROM INSURANCE FROM.

THEY'RE MANAGING THAT AND MEDICARE IS PAYING THE PREMIUM THAT THEY WOULD THEN PAY TO THE PROVIDER.

BUT THE PATIENT IS STILL PAYING INSURANCE PREMIUMS.

THEY STILL HAVE DEDUCTIBLES.

THEY STILL HAVE OUT OF POCKET MAXIMUMS.

ONE OF THE THINGS THAT HAS HAPPENED, IN MOST STATES, INSURERS NEGOTIATE WITH A PROVIDER, HEALTH SYSTEM, HOSPITAL, PHYSICIAN, WHAT THEY WILL REIMBURSE FOR PROCEDURES.

THAT'S A NEGOTIATION BETWEEN THOSE ENTITIES.

CONTRACT BY CONTRACT.

TYPICALLY IN MOST STATES, IT'S 140% OF WHAT MEDICARE WOULD PAY FOR THE SAME THING.

AUTO MEDICARE ADVANTAGE PLANS IT'S CLOSER TO 100 OR 105% OF WHAT MEDICARE WOULD PAY AND LAYERING ON THE PROFITS FROM THE ADMINISTRATION SO A LOT OF HEALTH SYSTEMS ARE SAYING WE CAN NO LONGER AFFORD TO SEE PATIENTS THAT HAVE MEDICARE ADVANTAGED PLANS.

LARGE SYSTEMS ARE SAYING, THEY'RE SAYING, IF YOU HAVE A HUMANA ADVANTAGE PLAN, WE WILL NO LONGER-- THAT'S NOT IN NETWORK.

IF YOU COME IN, YOU ARE PAYING-- WE ARE NOT CHARGING YOUR INSURANCE.

YOU WILL BE ON THE HOOK FOR THE ENTIRE COST.

>> NOT TO PUT TOO FINE A POINT ON THIS.

WHEN YOU HAVE A LARGE CORPORATION AS A-FOR-PROFIT ENTITY, THEY'RE MAKING MONEY OFF OF THIS RMT AND YOU BRING IN MORE REVENUE OR PAY OUT LESS.

SOME OF THE THINGS WE ARE SEEING WITH THE ADVANTAGE PROGRAMS, THEY'RE PAYING OUT LESS.

PREMIUMS ARE GOING UP.

DEDUCTIBLES ARE GOING UP.

>> IF I'M A PROVIDER.

>> SWEEZING IT FROM BOTH SIDES.

>> SO TELL ME, WHAT IS YOUR MODEL AND HOW DOES IT WORK?

>> SO, WE OFFER, TO HEALTHCARE PROVIDERS, WE-- MOST HEALTHCARE PROVIDERS OUTSOURCE THEIR PATIENT BILLING, SO MEANING YOU HAVE INSURANCE, YOU HAVE TO GO TO THE HOSPITAL, LET'S SAY YOU HAVE ELBOW SURGERY.

YOU ARE GOING TO HAVE SOME COSTS.

THEY'RE GOING TO BILL YOUR INSURER FOR WHATEVER THE NEGOTIATED RATE IS FOR THAT AND THERE ARE COMPANIES THAT DO THAT FOR HEALTHCARE PROVIDERS.

NEGOTIATE WITH THE PROCESS THROUGH THE CLEARING HOUSES AND PROCESS THAT CLAIM WITH THE INSURANCE COMPANY MAKE SURE THE CLAIM IS GOOD AND THEN THE INSURANCE COMPANY WILL EVENTUALLY PAY THE PROVIDER FOR THAT.

BUT THEN THE PATIENT'S RESPONSIBILITY IS REALLY ON THE PROVIDER.

THEY HAVE TO BILL FOR IT.

THEY HAVE TO COLLECT FOR IT.

THEY HAVE TO DO ALL OF THIS POINT OF SALE STUFF.

YOU GO TO A RESTAURANT.

ORDER FOOD, KNOW WHAT THE PRICE IS, YOU PAY THE BILL.

WHEN YOU WALK INTO A HOSPITAL... >> NO IDEA.

>> NO IDEA WHAT IT COST, NO IDEA WHAT YOU ARE GOING TO PAY, NO IDEA WHAT YOUR BENEFIT IS WITH YOUR INSURANCE PROVIDER.

>> THAT'S RIGHT.

>> AND NO ONE IN THAT MODEL IS INCENTIVIZED FOR YOU AS THE PATIENT TO KNOW THAT.

YOU HAVE PROBABLY GOTTEN YOUR INSURANCE THROUGH YOUR EMPLOYER.

THEY DON'T WANT YOU TO KNOW WHAT YOUR DEDUCTIBLE IS GOING TO BE THAT YOUR DEDUCTIBLE HAS GONE UP.

YOUR PREMIUM WENT UP 5% BUT YOUR DEDUCTIBLE WENT UP 5% AND OUT OF POCKET MAXIMUM WENT UP 5%.

NOBODY HAS INCENTIVIZED FOR THE PATIENT TO BE A GOOD CONSUMER OF THEIR OWN HEALTHCARE.

SO YOU WALK IN, 90, 120 DAYS LATER, YOU GET A BILL FROM THE HOSPITAL, THE FIRST THING YOU'VE SEEN, MAYBE YOU GOT AN EOB, EXPLANATION OF BENEFITS FROM YOUR INSURANCE CARRIER BUT THOSE NUMBERS DON'T ALWAYS MATCH WITH WHAT THE HOSPITAL BILLS YOU BECAUSE THAT'S BASED ON A NEGOTIATED RATE.

AND THEN SOME DISCOUNT-- YOU KNOW, THOSE NUMBERS MAY NOT ALWAYS MATCH.

SO THEN YOU GET THIS BILL-- YOU HAVE GOT AN EOB, THAT'S WHAT I'M GOING TO OWE.

BUT WAIT, THAT NUMBER DOESN'T MATCH.

AND IT'S MORE THAN I THOUGHT I WAS EVER GOING TO HAVE TO PAY.

SO THEN IT'S A DANCE BETWEEN COMPANIES THAT DO WHAT WE DO, TRYING TO COLLECT FOR THE PROVIDER, BUT DO THAT IN A WAY THAT IS HELPING PATIENTS AFFORD IT AND DO IT AFFORDABLY.

MOST TIMES, IF YOU HAVE EVER GOTTEN A MEDICAL BILL, IT CAME IN YOUR MAIL BOX, A PIECE OF PAPER, HARD TO UNDERSTAND.

>> IMPOSSIBLE.

>> THERE WERE TWO WAYS TO PAY.

MAIL A CHECK OR MAYBE GO TO A WEBSITE AND MAKE A FULL OR PARTIAL PAYMENT WHAT WE DO IS WE WILL STILL SEND YOU A PAPER STATEMENT.

WE ALSO WILL SEND YOU AN SMS MESSAGE WHERE YOU CAN CLICK ON THE BUTTON, SEE YOUR BILL, MAKE A DIGITAL PAYMENT.

WE ALSO ALLOW YOU TO SET UP PAYMENT PLANS.

SO PAYMENT PLANS UP TO 60 MONTHS, DEPENDING ON THE SIZE OF THE BALANCE, THE GOAL IS ALWAYS TO HAVE, ALLOW FOLKS TO HAVE A PAYMENT A MONTH OF AROUND $100.

MOST FOLKS CAN FIT $100 PAYMENT INTO THEIR BUDGET IN A GIVEN MONTH, ESPECIALLY IF THEY KNOW IT'S FOR THEIR HEALTHCARE.

AND IF IT GIVES THEM CONTINUED ACCESS TO THEIR HEALTHCARE.

YOU ARE SEEING SOME SYSTEMS THAT, DEPENDING ON HOW LARGE OF AN OUTSTANDING DEBT YOU MAY HAVE WITH THEM AS A PATIENT, THEY ARE NOW STARTING, ESPECIALLY FOR ELECTIVE THINGS, THEY'RE STARTING TO SAY WE CANNOT CONTINUE CARE UNTIL YOU DO SOMETHING ABOUT THIS DEBT.

EITHER YOU KNOW, YOU'VE GOT TO START MAKING PAYMENTS ON IT, NEED TO MAKE A MINIMUM PAYMENT, WHATEVER THAT IS, YOU ARE STARTING TO SEE THAT MORE AND MORE.

SO WE TRY TO TAKE A DIFFERENT ANGLE.

LET'S GIVE THE PATIENT A PAYMENT PLAN THAT'S AFFORDABLE THAT WE KNOW THEY CAN AFFORD.

THEY CAN PAY OVER TIME.

MAKE IT EASY AND SIMPLE FOR THEM TO DO THAT AND THEY CAN CONTINUE TO GET ACCESS TO THE CARE AND IF THEY NEED TO ADD ADDITIONAL EXPENSES TO THE PAYMENT PLAN, WE CAN WORK WITH THEM TO DO THAT.

>> HOW ARE YOU BUFFERING THE PIECE THAT YOU MENTIONED EARLIER WHERE YOU GOT A LARGE BILL FROM THE HOSPITAL AND THEY SAY PAY WHAT YOU WANT FOR THE FIRST COUPLE OF MONTHS AND THE THIRD MONTH-- HOW IS IT THAT YOU ARE ABLE TO LEVERAGE SAYING HEY WE'LL SELL UP A PAYMENT PLAN AND NOT SEND THEM THE HUGE BILL.

>> IN MOST INSTANCES, WE ARE THE ONE SENDING THE BILL.

WHEN WE FIRST DESIGNED THE PRODUCT, ONE OF OUR ASSUMPTIONS WAS THAT MOST OF THE PAYMENT PLANS WOULD BE ELECTIVE PROCEDURES AND THE PATIENT WOULD BE ENROLLED PRIOR TO THE PROCEDURE AT SCHEDULING.

SO MOST PROVIDERS NOW BY STATUTE, YOU ARE SUPPOSED TO, FOR A CERTAIN NUMBER OF PROCEDURES PROVIDE AN ESTIMATE WHAT YOU EXPECT THE PATIENT TO OWE OUT OF POCKET IT IS SUPPOSED TO BE DIRECTIONALLY CORRECT.

>> OVER THERE.

>> HAVE YOU TO HAVE KNEE REPLACEMENT OR SOMEONE HAS TO HAVE KNEE REPLACEMENT.

BASED ON YOUR INSURANCE WE ESTIMATE AND HOW MUCH YOUR DEDUCTIBLE YOU'VE ALREADY USED THAT YOU ARE GOING TO OWE $3500.

HOW DO YOU PLAN TO PAY FOR IT?

I CAN'T.

WE HAVE A PAYMENT PLAN OPTIONS.

HERE ARE THE TERMS YOU CAN CHOOSE.

WE CAN GET YOU A PAYMENT OF AROUND 100 A MONTH.

>> THAT'S WHERE YOU COME IN?

>> WE WOULD HAVE THE PAYMENT PLAN THAT THEY WOULD ENROLL IN AND GET ON THE SCHEDULE AND HAVE THE PROCEDURE DONE.

WHAT WE HAVE SEEN IS MOST HEALTHCARE PROVIDERS ARE NOT THAT PROACTIVE ABOUT IT.

THEY JUST GO AHEAD AND DO THE SCHEDULE.

THEY SAY GIVE US YOUR INSURANCE INFORMATION.

THEY GET IT ON FILE AND THEY PUT YOU ON THE SCHEDULE.

YOU HAVE THE PROCEDURE DONE, THEY FIND OUT WHAT THE INSURER IS GOING PAY YOU FOR IT AND THEN THEY SEND YOU A BILL.

SO JUST FROM A CUSTOMER EXPERIENCE PERSPECTIVE, IT'S THE ONLY PRODUCT THAT I KNOW IN THE U.S. WHERE YOU CAN HAVE-- YOU CAN HAVE THE ENTIRE PRODUCT DELIVERED TO YOU WITHOUT EVER KNOWING WHAT YOU ARE GOING TO OWE.

>> NO CLUE.

>> SO THERE ARE OBVIOUS DIFFERENCES.

HOW DOES YOUR MODEL DIFFER FROM WHAT SOME MUNICIPALITIES ARE DOING, PARTNERING WITH PRIVATE ENTITIES TO PAY THE BILL FOR AN INDIVIDUAL?

>> YEAH, MOST OF THOSE-- MOST OF THOSE ARE CHARITY-BASED PROGRAMS WE CANNOT NON-PROFIT OUR WAY OUT OF THIS PROBLEM.

WE FUNDER, THE CROWD FUNDING WEBSITE WHERE FOLKS CAN, IF YOU ARE A SPORTS TEAM, YOU CAN CROWD FUND ALL SORTS OF THINGS.

THEY PUT OUT A REPORT THAT SAYS THEIR LARGEST CATEGORY FOR FOLKS RAISING FUNDS IS MEDICAL EXPENSES.

YOU ARE PUTTING OUT I CAN'T AFFORD MY MEDICAL EXPENSES, PLEASE HELP ME PAY FOR THAT.

WE ARE NOT GOING TO BE ABLE TO PAY FOR ALL OF OUR MEDICAL EXPENSES THAT WAY.

I THINK WHAT YOU HAVE TO DO IS WITHOUT TAKING THE WHOLE SYSTEM AND JUMPING IT UPSIDE DOWN AND COMING UP WITH A NEW MODEL,.

>> PROBABLY NOT A BAD IDEA.

>> PROBABLY NOT BUT I'M NOT SURE WE WILL GET THERE ANY TIME SOON WE HAVE TO MAKE LEMONADE WITH THE LEMONS WE HAVE BEEN GIVING.

THAT'S WHAT WE ARE TRYING TO OFFER, IT'S COMPLETELY FREE TO THE PATIENT.

THEY DON'T PAY US A DIME.

WE MAKE OUR MONEY FROM THE PROVIDER.

SO IT'S JUST A NEW BENEFIT THAT PROVIDER IS OFFERING TO YOU TO SAY WE KNOW YOU ARE HAVING TO PAY MORE FOR FOR THE SERVICES THAT WE PROVIDE.

OUR SORT OF NORTH STAR IS NO PATIENT SHOULD GO BANKRUPT BECAUSE THEY GOT SICK AND PROVIDERS SHOULD GET PAID FOR THE GREAT SERVICES THAT THEY PROVIDE.

WE SORT OF SIT IN THE MIDDLE AND WE ARE FIGURING OUT A WAY THAT THAT PATIENT CAN AFFORDABLY PAY THAT DOCTOR OR HOSPITAL WHAT THEY OWE THEM FOR THE GOOD SERVICES THAT THEY DELIVERED.

TRYING TO NON-PROFIT OR, THROUGH THE GOODNESS OF WEALTHY BENEFACTORS YOUR WAY OUT OF THAT.

IT'S 20% OF THE U.S. ECONOMY.

THERE'S 400 BILLION IN OUT OF POCKET EXPENSES FOR COMMERCIALLY INSURED PATIENTS EVERY YEAR.

YOU CAN'T NON-PROFIT YOUR WAY OUT OF THAT.

>> ARE YOU AN INTERMEDIARY OR NEXT STEP AS WE LOOK AT UNIVERSAL HEALTH PLANS AS WE TALK ABOUT THAT SORT OF THING?

>> SO, I THINK WHAT YOU WILL SEE WITH UNIVERSAL HEALTH PLANS-- AND YOU SEE THIS IN WESTERN-- OR EUROPEAN COUNTRIES THAT HAVE UNIVERSAL HEALTH.

YOU WILL GO ON THE NATIONAL HEALTH SYSTEM, BUT IN GERMANY AND IN ENGLAND, IN CANADA, THERE IS STILL A PRIVATE INSURANCE MARKET.

IT'S LAYERED OVER THE TOP.

SO YOU ESSENTIALLY SORT OF GET THE BASIC CARE THROUGH WHATEVER TAXES YOU ARE PAYING FOR FOR THE GOVERNMENT SYSTEM AND IF YOU WANT, YOU CAN LAYER SOMETHING ON TOP OF THAT THAT PROVIDES YOU ADDITIONAL BENEFITS BUT IT COMES WITH ALL THE SAME THINGS OUR INSURANCE COMES WITH.

DEDUCTIBLE, OUT OF POCKET MAXIMUMS.

THINGS IT WON'T COVER.

SO I THINK SOMEONE IS ALWAYS GOING TO HAVE TO MANAGE THAT MANAGED CARE.

I THINK IF YOU LOOK AT IT FROM THE INSURANCE INDUSTRY IN THIS COUNTRY, I THINK THEY ARE SETTING THEMSELVES UP, IF AND WHEN THAT DOES HAPPEN, THEY WILL BE THE FOR-PROFIT MANAGERS OF WHATEVER NATIONAL, YOU KNOW, WHETHER IT'S MEDICARE FOR ALL OR WHATEVER.

THEY WILL FIND A WAY TO SET IT UP SO THAT THEY WILL BE THE ONES THAT MANAGE IT.

AND IT WILL PROBABLY BE LOOK MUCH LIKE A MEDICARE ADVANTAGE SITUATION DOES TODAY WHERE THEY WILL GET PAID BY THE U.S. GOVERNMENT TO MANAGE IT AND THEY-- THERE MAY BE SOME WHERE PATIENTS WILL PAY-- THE MEMBERS WILL PAY THEM SOME AND THE GOVERNMENT WILL PAY SOME.

>> THERE ARE ANY OTHER MODELS LIKE YOURS AROUND?

>> MOST OF THE MODELS, AT LEAST ON THE PAYMENT PLAN SIDE ARE INTEREST BEARING.

SO CARE CREDIT, FOR INSTANCE, IS THE 600-POUND GORILLA IN THE ROOM, OLD G.E., OWNED BY SYNCHRONY.

IT'S A CREDIT CARD ESSENTIALLY.

YOU APPLY PLY FOR A CREDIT CARD.

COMES WITH CREDIT CARD INTEREST RATES, YOU CAN USE IT FOR DENTAL EXPENSES OR A NUMBER OF HEALTHCARE EXPENSES.

HEALTHCARE SPECIFIC BUT CREDIT CARD INTEREST RATES PAYING 16, 17, 18, 1920%.

>> ON THE BALANCE.

>> ON THE BALANCE.

>> OH MY GOODNESS GRACIOUS.

SO IMAGINE HAVING DENTAL SURGERY, NOBODY'S INSURANCE COVERS ANYTHING OTHER THAN THEIR TWICE ANNUAL CLEANINGS, ESSENTIALLY.

YOU MAY HAVE A SMALL BENEFIT WITH YOUR HEALTH INSURANCE.

BUT IT'S NOT GOING TO COVER MUCH.

IF YOU HAVE TO GET A BRIDGE OR 2500 OR 3,000, HOW ARE YOU GOING PAY FOR THIS?

WE CAN'T.

I'M SORRY, WE CAN'T PROVIDE THE PROCEDURE.

WE HAVE THIS CREDIT CARD.

MOST OF THEM ARE INTEREST BEARING.

>> SO THERE IS A PROFIT MOTIVE IN THAT SORT OF THING.

>> WE ARE FOR-PROFIT.

THERE IS A PROFIT-MOTIVE FOR US.

WE JUST FIGURED OUT HOW TO NOT CHARGE THE PATIENT.

THE HOSPITALS ARE COLLECTING 50 CENTS ON THE DOLLAR WITH WHAT THAT PATIENT OWES THEM.

IF WE CAN GET THEM TO PAY, AND WE'LL PAY YOU 75 CENTS ON THE DOLLAR FOR WHAT THAT PATIENT OWE YOU AND WE WILL PAY IT TYPICALLY WITHIN 60 DAYS AFTER THAT PROCEDURE WAS COMPLETED, AND THEN WE COLLECT THE FULL BALANCE, THAT'S A GOOD DEAL FOR THE PATIENT.

IT'S A GOOD DEAL FOR US AND IT'S A GOOD DEAL FOR THE PROCEDURE BECAUSE THEY COLLECT MORE AND THEY DO IT SIGNIFICANTLY FASTER THAN THEY WOULD BE ABLE TO COLLECT ON THEIR OWN.

>> SO YOUR A.I.

GENERATED NAME REPATIENT I THINK IS BRILLIANT BUT YOU ARE REPAYING THINGS FOR THE PATIENT.

>> TO THE PROVIDERS THAT THEY ALREADY OWE.

>> CHRIS, I'M DISAPPOINTED.

I THOUGHT FOR SURE YOU CAME UP WITH THIS ON YOUR OWN.

>> WE HAD A LIST, YOU KNOW... WE PUT THE WORDS IN... AND IT GENERATED.

[LAUGHTER] >> GENERATED THINGS AND WE CHOSE IT.

>> THANK YOU VERY MUCH FOR BEING WITH US TODAY.

THIS IS A TOPIC I'M KIND OF INTERESTED IN.

HOW DO WE PAY FOR HEALTHCARE AND YOU KIND OF HELPED ME ALONG A LITTLE BIT.

WE MIGHT HAVE TO GET YOU BACK HERE TO TALK MORE ABOUT THIS.

I WOULD LIKE TO THANK YOU FOR BEING WITH US TODAY ALSO.

IF YOU ARE STRAINED FINANCIALLY BECAUSE OF HEALTHCARE COSTS, SEEK COUNSEL WITH ORGANIZES LIKE REPATIENT.

AND TALK TO THE FINANCIAL SERVICES ARM OF YOUR HEALTHCARE PROVIDER AND HOSPITAL TO RESTRUCTURE A PAYMENT PLAN.

I HOPE THAT YOU SEE THAT IF YOU ARE IN A BIND, YOU ARE NOT ALONE.

AND THERE IS NO SHAME IN LOOKING AND ASKING FOR HELP.

IF YOU WISH TO WATCH THIS SHOW AGAIN OR ARCHIVED VERSION OF PAST SHOWS, PLEASE GO TO WWW.ket.org/HEALTH.

IF YOU HAVE A QUESTION OR COMMENT ABOUT THIS OR OTHER SHOWS, WE CAN BE REACHED AT KYHEALTH@ket.org.

I LOOK FORWARD TO SEEING YOU THE NEXT TIME ON "KENTUCKY HEALTH" AND PLEASE IF YOU HAVE CONCERNS ABOUT YOUR HEALTHCARE BILLS, SEEK OUT HELP AND CONSULTATION.

THANK YOU.

>> "KENTUCKY HEALTH" IS FUNDED IN PART BY A GRANT FROM THE FOUNDATION FOR A HEALTHY KENTUCKY.

DML