A specialist who deciphers medical bills
Hospitals and clinics don’t always get it right when they send bills to patients.
And with all the codes and jargon on medical bills, it can be tough for consumers to spot the mistakes, let alone get them fixed.
Athos Health, a startup based in St. Paul, wants to help people review their medical bills so patients don’t wind up paying hundreds or thousands of dollars in unnecessary out-of-pocket costs.
Those costs are more likely as more health insurance policies feature high deductibles where patients must spend thousands of dollars out-of-pocket before full coverages kick in.
Jonathon Hess, one of the company’s co-founders, said patients need help deciphering bills because the system really wasn’t designed with individual consumers in mind.
“It was built up as a business-to-business industry,” Hess said in an interview, referring to the health care providers that generate bills and the insurance companies that provide most of the payment. “Now, because of the rise of out-of-pocket expenses, the consumer is getting a bigger voice, but the providers aren’t set up to deal with that.”
In 2015, 96 percent of people with private employer plans in Minnesota had a deductible with their coverage, up from 52 percent in 2002, according to the Minnesota Department of Health.
The average individual deductible in these plans last year was $1,819 — up from $1,419 in 2014, according to an analysis by the department’s Health Economics Program.
The trends mean that individual patients have a much greater chance of needing to pay a medical bill out-of-pocket. Estimates on the frequency of errors in those bills vary widely, said Betsy Imholz of Consumers Union.
“I’ve seen the American Medical Association estimate it at 7 percent, but others would put it much higher,” Imholz said via email. “Hospital bills are particularly known for inaccuracies, with some estimates showing 90 percent have errors.”
Hess, 41, of St. Paul worked for more than 15 years as a health care consultant, including work on systems that hospitals and clinics use for issuing and collecting bills.
Beyond checking for mistakes, Athos Health can provide patients with information about how costs for a particular service compare with rates elsewhere. Patients can ask the company to negotiate with a clinic or hospital to see if a discount is possible.
Hess and two co-founders, who also were health care consultants, started testing the business concept with friends and family in 2015. They established the business earlier this year as a limited liability company.
Currently, Athos Health is making the service available to people through their employers without a subscription fee. When they catch a mistake, the company retains 25 percent of the savings up to $500.
Starting this fall, the model will shift. Employers will pay a fee for the service, Hess said, and Athos Health will return 100 percent of the savings to individual patients.