A personal essay and case study (~5 minutes read time)

As patients, we all want to believe that the healthcare facilities we turn to for treatment are there to take care of us. And it's true that the doctors we're seeing usually are. But a hospital is more than just doctors and nurses, and the sad truth is that many hospitals are more interested in extracting money from vulnerable patients than providing quality care at a fair price. They usually get away with it, too, because the leverage they hold - a person's access to care - makes it seem like they can demand as much money as they want, while making the payer feel like there isn't another option.

The good news: it doesn't have to be this way. There are good men and women across our industry who have both the will and the audacity to fight back, and they’re showing us that with vigilance and a little know-how, even one person really can make a difference. Because a good plan administrator knows the truth: greedy healthcare participants like hospitals don’t have quite as much leverage as they’d like us to think.

When Flume Health stepped in to replace Blue Cross Blue Shield for one client’s health benefits, we found a problem even worse than their out-of-control premiums: member health was being neglected. 

The patient in question had been suffering from lung problems for six years, but the incumbent's TPA was not actively managing his care. Now he had ended up in the ER, and the doctor was recommending a full lung transplant!

Left on his own, the patient likely would have gone straight to the nearest hospital to get on the waitlist, without even realizing that he had other options. The employer would have paid the bill regardless of whether it was overpriced, and the status quo would have rolled on...

Instead, Flume Health delivered a win-win-win for the patient, CEO, and provider by providing an opportunity to:

• get the patient better care with no out-of-pocket cost
• save the employer a ton of money
• give the provider a clear and easy path to billing

Here's how we did it: