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Category: Matthew Holt

Matthew Holt is the founder and publisher of The Health Care Blog and still writes regularly for the site and hosts the #THCBGang and #HealthInTwoPoint00 video shows/podcasts. He was co-founder of the Health 2.0 Conference and now also does advisory work mostly for health tech startups at his consulting firm SMACK.health.

How exactly is my lab test co-pay $34.94?

By MATTHEW HOLT

I moved over something I wrote on linkedin, so that it doesn’t vanish. I do this type of thing so you don’t have to & to make Brett Jansen happy I am writing in one line paragraphs.

My question, is how do LabCorp, Brown & Toland and Blue Shield Of California come up with this stuff?

1. I go for my free annual checkup

2. I get blood/lab tests which AFAICT are included in the ACA free checkup.

3. My pre-diabetes is still “pre”. My cholesterol is good!

4. Blue Shield of California puts the claim on its website. The EOB representation says
–total billed $322.28
–In network savings $271.37
(note difference is $50.91)
–Patient responsibility $0

5. Then it has 5 sub-charges for different tests (which I assume total to the $322.28). All have a different price. All say “in network savings” of the same amount. All say Patient Responsibility $0

6. Labcorp sends me a bill. For $322.28. “Adjustments” $287.34. Difference $34.94.

7. I call Blue Shield of California customer service. Its annoying as hell automated system reads me the claim EOB that I can see on the website.

8. After a few minutes of that I hit 0 and get a human eventually. After a loooong time she goes to call Brown and Toland, the IPA that is somehow involved in the lab billing. They tell her that I do indeed owe $35. (26 mins on the call)

9. I ask her why, given they are allegedly free under the ACA, I am being charged for these lab tests. She says that the medical group has sent her the CPT codes and she can tell me which of the 5 lab tests I owe for.

10. (On the Labcorp bill the charges are split up by test [no codes provided], but the “adjustment” is to the total, so there’s no way to tell what the adjustment per test is. Reminder that on the BS site, they all adjust to $0.)

11. But that information is not in whatever documentation the IPA gave her. She goes back to call them AGAIN. Because, yes I am difficult and I did ask her to. Minute 37 at this stage

12. Minute 45. The person from the IPA comes on line. She keeps asking if I want a service or a diagnosis code. But tells me they will review the claim. My guess is that one of these codes doesn’t count as preventative. Eventually she gave me the 5 CPT codes for the tests.

13. The BS rep is still on the call. She chimes in and the IPA rep (who I think is in India judging by accent and bad phone connection) agrees that my lab copay is $50. (BTW the BS rep is clearly American but her phone connection is dreadful too!)

14. After a lot of clarification (OK, me leading the witnesses) they both agree that if the co-pay is $50 but my bill is $34.94, then something is off, and maybe one of the codes has been classified as non-preventative, therefore not free under the ACA.

15 The IPA (Brown & Toland Physicians) rep is going to resubmit this to the claims team. I should get a new EOB. From whom I have no idea. I thank them both for their time and we hang up. 1 hour 4 minutes

I know that wasted more than $34.94 of my time, and certainly way more than that of Blue Shield of California & Brown & Toland Physicians money. But it’s just an indication of how screwed up internal billing and customer service is at these antique orgs!

If you want to follow along, there’s a part 2!

Matthew Holt is the founder, author and publisher of THCB

Ami Parekh & Ankoor Shah, Included Health

Ami Parekh is the Chief Health Officer & Ankoor Shah, is VP, Clinical Excellence at Included Health. I had a long conversation with them about the philosophy of how we are doing population health and how we fix the system that we have today. I’m arguing for more primary care, but Ami restated it and says, you need somone you trust who is an expert who can help you make decisions. And this might not be a human! How do we change the system, and how does telehealth work now and how will it change? Defining health from the person perspective, not the way the health system wants to define it! Matthew Holt

Are the MA(HT)GA crowd going to be proud of themselves?

By MATTHEW HOLT

I have been trying hard to suppress this line of thought but when I woke up in the middle of the night with this piece basically fully formed in my head I couldn’t not write it. Yes I might lose some friends, but someone in health tech has to say this.

Last week a bunch of health tech companies, providers, plans and others went to the White House to an event remarkably called “Make American Health Technology Great Again”. The main organizer Amy Gleason is someone I consider an industry friend. No one can doubt her credentials in wanting to help patients, especially given her daughter Morgan’s medical condition and her awful experience in the health system. The initiatives spelled out–while they are voluntary and based on actions and regulations that are already on the books–will be net net good for American health care, and good for patients. 

Now, almost everything proposed is happening anyway. Anyone in health tech knows that it’s much easier to get health data and to run AI on it than it was in 2020, and it was way easier to get health data in 2020 than it was in 2016. Yes, of course it should be better and easier than it currently is. Yes, it should have happened quicker. Yes, the big provider systems and their main EMR Epic have not exactly bent over backwards to make data access more convenient for patients and innovators. Yes, of course there are too many demands to “send us a fax”. I personally had great fun with a UCSF-affiliated hospital last week, speaking to 5 different people and ending up both emailing and faxing them a referral to get an appointment. I’m pretty sure I’ll be doing the same thing in 2028. 

You can read tons more about the plans, the event and the voluntary agreement from luminaries like Lisa Bari and new dad Brendan Keeler.

But none of that is what is troubling me. What is deeply disturbing is the normalization of the people allegedly in charge of the nation’s health and health tech and the nonchalance and even knee-bending of those who went to the event last week.

Now I wasn’t there, even if several industry friends and clients were. I was at several similar events back in the Obama administration, but what we have seen from this Trump administration is a radical and toxic departure from America’s leadership in health and democracy, and it is not acceptable.

This is encapsulated by the people on the dias, and the actions they have taken.

Trump and his administration have committed so many egregious authoritarian acts that there’s no way to list them all. Just because people voted for him and the Congress and Judiciary is neutered does not obviate the fact that he was – deep breath – convicted of rape and separately found to be lying about mortgages in a civil court; convicted of 34 felonies for essentially tampering with the 2016 election; and impeached twice–once for politicizing America’s foreign policy and once for starting a violent coup. Don’t forget that at the time of the 2024 election he was being–another deep breath–prosecuted for stealing (and presumably selling) state secrets; being prosecuted for vote tampering in Georgia; and being prosecuted for planning the coup on Jan 6. It’s worth pointing out that two countries that have recent experience of dictatorships (Korea and Brazil) have both prosecuted and banned from office the leaders who attempted similar crimes there. (Incidentally I highly recommend you watch I’m Still Here, the Oscar-winning story of one family whose father was “disappeared” under Brazil’s military dictatorship in the 1970s).

Since his return to office, Trump has overseen the greatest direct political corruption ever in this country – you can bribe him directly via his memecoin. He has also overseen the transformation of ICE into an American-style Gestapo. Masked unidentified ICE agents are now snatching people, including both citizens and legal immigrants, off the streets and burying them in concentration camps here and abroad. Don’t forget that many immigrants or first generation immigrants are heading up those health tech companies at the meeting last week, not to mention how many poor, and perhaps undocumented, immigrants are working in our health care system. 

I haven’t even mentioned the impending cuts to Medicaid, the program for the poorest Americans, which will be the result of Trump’s “One Big Beautiful Bill Act”. That is sure to have a terrible effect on patients and on much of the health system, including many health tech companies trying to support Medicaid patients.

I didn’t even mention Epstein! And this is the guy America’s health care community wants to go and politely applaud just because he reads a speech about interoperability?

And it doesn’t stop there.

Continue reading…

Emily & Me–Money Remaking Medicine

The super connector and super intelligent Emily Peters, (who has quite her own patient adventure story–tl:dr GO GIVE BLOOD) and has written several books including Artists Remaking Medicine, is working on another one called Money Remaking Medicine. She invited me on a show called the Positive Deviants Detectives which is kind of a book club called the Health Care Reinvention Collaborative all hosted by the very wise Dawn Ellison. We talked and the audience joined in about the history of money, HMOs and more in health care and whether we can re-fangle it to make the money do the right things. Matthew Holt

Steve Brown, CureWise — AI for patients

Steve Brown is a genuine digital health OG. Starting with video games for kids with diabetes he eventually turned Health Hero into one of the first disease management companies. It was used in the VA to manage patients at home with CHF, diabetes and more and eventually sold to Bosch. Steve left health care for 15 years, but then at the start of this year had his own health issue. Which turned out to be cancer. He turned to AI and has built an amazing early stage patient facing AI doctor, called CureWise. It essentially has turned LLMs into multiple doctors. He gave me a full and fascinating demo. This is clearly the future but it’s also the present for Steve who is patient zero and the first user as well as the CEO. Amazing stuff. — Matthew Holt

V Bento, Sword Health

I got to interview V Bento the CEO of Sword Health. We had been in a little back and forth on Linkedin but this was the first time we actually had talked. Almost all of their business is in the US in MSK but they have recently added mental health and V is not shy in talking about the other areas they are heading into. They have had some controversial moments. They just raised money at an amount ($4 Bn) higher than larger rival MSK health outfit Hinge Health is trading at on the public market. Then I used it a year ago via Blue Shield of CA, and found it effective but expensive. Finally, there’s a lawsuit from the folks at Aging 2.0 who claim that they are owed equity from an accelerator Sword was part of in the 2010s.

V talked about all of these, specifically about how they are now charging their clients, and why he thinks they are worth their valuation–which apparently has no special terms for general Catalyst which invested at that valuation. He wouldn’t talk about the lawsuit other than to say he was happy with his position. But we had a good discussion and got to hear about their new tech, including their use of AI, and why V is so bullish on the company moving beyond MSK. Matthew Holt

Dominique Wells, Conduit Health Partners

Dominique Wells is COO of Conduit Health Partners which is a spin off from the (now) Bon Secours Mercy Health system. Their role is to provide back up for nursing staff for health systems in very specific areas, notably patient transfer operations, nurse triage and patient communications. Dominique and her team showed me a brief demo of how the transfer operation works. We also got into the conversation about the role of AI in nursing, and how nursing has changed since the pandemic. An interesting discussion about how the most vital role in health care is changing and how new services are being developed to adapt to it—Matthew Holt

Matthew tries Reperio’s at home health screening

We are entering an age of at home testing and the team at Reperio just raised $14m to make weight, blood pressure and cholesterol/blood sugar testing available at home. But this is a relatively complex series of tests, intended to get people who haven’t been to a primary care doctor back into the system. How is the experience and can we expect people to do it? And does the result correlate with standard lab testing? They sent me the box for me to find out. I totally screwed it up the first time (apparently only 4% of people do), but they gave me another chance. So come along with me to find out how it works. Would you do this, or just go to Labcorp?! — Matthew Holt

BTW since I did this Reperio released an early customer study that said 23% of those who used the kit found a problem they weren’t aware of. Which is I guess the point!

Anmol Madan, RadiantGraph

Anmol Madan is CEO of RadiantGraph. He’s building an end to end solution that goes from data ingestion to applications to consumer connection via text/email and voice in order to let payers quickly roll out patient engagement plans. His idea is that plans/payers don’t need to fix their data, RadiantGraph’s AI can take the messy data and and then add an AI layer, and on that create specific applications–Anmol showed me a comprehensive demo. I also asked him if they are doing too much, or conversely if they need to do more!–Matthew Holt

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