https://www.eligibleapi.com/about-us - nothing https://www.eligibleapi.com/privacy - nothing https://www.eligibleapi.com/security - nothing https://www.eligibleapi.com/faq - yay, there's an email address :)
Seriously, what am I missing?
Sidenote: this is the reason why great hackers stay out of healthcare. you're scaring people away with this comment. I understand privacy needs to be taken seriously, but I do not think it should stifle innovation.
I'm not in the field yet, but I do have a business plan that deals with US healthcare, and lawsuits and the FDA are pretty scary :)
Edit: example HIPAA fines
http://www.ama-assn.org/ama/pub/physician-resources/solution...
That is one of the major issues preventing innovation in healthcare- the potential to lose a huge lawsuit. This article:
http://www.nytimes.com/2013/02/24/business/overcoming-obstac...
illustrated one of the main problems: the legal framework surrounding malpractice is completely screwed up. In the article, it is claimed that
"As it is now, a doctor or hospital can be sued if the plaintiff can show that “normal standards of care” were not followed, even if those normal standards of care are inappropriate."
Assuming that this is correct (I am neither a physician nor a lawyer), this basically freezes innovation, and makes it nigh impossible for innovation to occur.
In other words, just in case I don't understand - a random poster on HN can stifle innovation in the healthcare industry by posting a half serious (missing address) half joke (suing anyone) comment ? I'm so happy I live in Europe :)
I'm a health care informatics professional (mostly clinical, not billing) and I can't seem to divine it.
There are ANSI standard EDI transactions designed specifically for healthcare insurance eligibility inquiries (there also exists transactions for claims, but that's the other side of the puzzle). The standards themselves are pretty simple. But unfortunately, from a business development and integration perspective, the effort required to become trading partners with healthcare insurance companies is extremely high. There are plenty of vendors and clearinghouses out there which make the process easier. But this company is trying to make the setup and integration even easier with self-service sign-up and credit card billing. It's a novel idea.
Edit: I have no affiliation with Eligible but I've been working with the underlying technology for many years.
It does look very useful :)
Before a test or lab is ordered, or before a specialist visit is scheduled, one of the assistants needs to verify that your insurance will actually cover the procedure. Typically this means the assistant needs to call the insurance provider, give them your information and what procedure(s) they are checking on.
Insurers provide this data but there are close to a dozen disparate standards and formats. Eligible consolidates all that into a REST API that developers can build applications on top of. From what I can tell this is definitely not for the healthcare industry, but for our industry to build healthcare applications.
I have no affiliation with Eligible, but I've been working in healthcare IT for several years, although not at the startup level.
Also, I'd advise you not to jump straight to messages about "non-technical bureaucracies." It's certainly true in some cases, but it sounds derogatory. Better to address the objectives these people are trying to meet.
The patient records (MRI, CT scan images, doctor writeups) are probably a lot harder to standardize I'm assuming?
That seems to be the missing piece from this API. Otherwise, great job you guys.. Open up the industry!
Their existing software often does a bad job of identifying the provenance of information or filtering out noisy irrelevant information, so unless they can be assured that everyone else is following the same policies around how things are documented and categorized, they're unwilling to mix a bunch of "outside" data with their own.
They also see little incentive to invest effort in opening up their own data to others, because it costs real money and doesn't really benefit them. This is where a good startup business could make a difference -- by doing the data exporting work "for free" in exchange for the ability to sell access to it.
I wonder about other parts of the chain (e.g. payer <-> provider) could benefit from this kind of tech-enabling?
Edit: edited n of free requests per t in eg
Good work. :D
Default risk was priced and risk was conserved!
Fast-forward to the present day, the insurance concept was applied to healthcare as a way to smooth out one's healthcare costs over a lifetime and eliminate tail-risk to the individual. Since the 1930s, the insurance industry has evolved into a system to avoid paying for your healthcare costs. First, the growing expenses were thrown onto the employer (think auto manufacturers) and when the employers can't support the cost, onto the healthy by passing cost increases on to employees through increased premiums.
The fact is that if you consume something, you or someone(s) else will have to fund your consumption. The second law of thermodynamics applies to healthcare as well. There is no free lunch here either.
Insurance companies end up as an additional layer of administration expense. In the case of financialization of health care, the administration is extraordinarily expensive!
Risk is conserved!
[1] = https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an...
