Show HN: A network for Americans who can't afford health insurance | Hacker News Reader

Show HN: A network for Americans who can't afford health insurance

pocketero.com

Hey HN, launched this recently and looking for early feedback.

The problem to solve: In the US, patients who can't afford health insurance are regularly charged the highest prices for healthcare - prices that are deliberately inflated by 2x-4x above market. But theoretically they should be getting the best prices, because they are paying without the expenses and delays of insurance claims. However, insurance contracts are written in a way that prevents anyone outside a network from getting better prices than insurers.

The Pocketero solution: An affordable non-insurance network for people who pay out of pocket for healthcare, especially those who can't afford health insurance. Network members get the best prices from network providers.

If you have any comments about the design, implementation, business model, etc. - please share your thoughts!

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I'm curious, lets say person A needs a complex surgery, gets a bill for 200k usd, because A uses Pocketero, A only pays 100k, do people actually pay that sum at once, or they just try to get a payment plan, etc...? Because for a low income family(the ones that can't afford insurance) a payment plan for 100k or 200k doesn't really make a difference (is a lot), and most low income family would just declare bankruptcy (they usually have low credit score anyway and are not in the housing market, or anything like that). What's is the point of paying for a service that would only get me a discount of a huge expense, instead of "guaranteeing" that I won't owe hundreds of thousands to a hospital(with an insurance)?

You're right, there are medical expenses so huge that even big discounts won't meaningfully help avoid bankruptcy. But let's not only consider worst case scenarios, let's also consider more common scenarios:

- A non-complex surgery that retails for $20k and is discounted to $5k (hopefully on a payment plan). - A specialist consultation that retails for $1000 and is discounted to $250. - An urgent care visit that retails for $400 and is discounted to $100.

There are 30 million Americans who don't have health insurance [1] largely because it costs $541/mo on average [2]. Aren't these people well served by a "best price" network at $10/mo?

[1] https://www.simplyinsurance.com/how-many-americans-dont-have... [2] https://www.valuepenguin.com/average-cost-of-health-insuranc...

You have your pricing model backwards IMO. If your target market are those who cannot afford healthcare are they in the position to pay monthly for the possibility of discounted service? I understand that when you run the numbers $10/mrr from 1000 customers vs 100 providers is more appealing, but if the system is worth using providers would be throwing money at you to acquire non-insured cash customers at a scaled rate.

How many customers are currently using the system? How many providers and services are available for the first few customers to search through? If there answer is none or close to none I'd think about making the service free to use until it is worth it for one side or the other (it should be providers) to start paying.

That's an interesting proposal: make it free for members and eventually build enough membership that providers are actively wanting to join the network for a monthly fee.

To be clear, I'm happy with any pricing model that accomplishes the goal of helping people who are stuck paying out of pocket for healthcare. But charging providers doesn't seem viable because providers seem quite un-motivated. In fact, Pocketero's biggest challenge right now is getting providers to reply to invites to join the network. Not because they are opposed - they are willing to join if we can speak to someone. Rather they are overwhelmed with customers. They don't reply to emails/faxes/voicemails, they only seem to join if you get them on the phone and walk them through it. Because they are so un-motivated, part of my pitch is "it costs you nothing" - hopefully leaving no possible objections to joining.

But you pose a good question: "those who cannot afford healthcare are they in the position to pay monthly"? I'm starting to think sponsorship is the most viable model - small businesses, churches, etc. paying for memberships en masse. I just added the sponsorship feature on Monday, and may soon pivot the homepage to focus on sponsors. What do you think about that model instead?

"Free to join" does not mean you have removed all friction from the process. There is time they have to spend thinking about it and probably discuss with other stakeholders. Inertia is the strongest force in the universe so you have to find what motivates them to join, not just what removes barriers. This is an important detail.

"We charge you $10/month so you can pay in cash".

Not exactly. It's more like, "You pay in cash either way, we charge you $10/month so you can get the best price instead of the worst price." (It's often a difference of 4x.) This way more people can afford to get the healthcare they need.

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