Common healthcare questions I get

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Some common healthcare qs

Here’s the thing about being “the healthcare guy”. My normie ass friends will now tag me in every post from instagram accounts targeting mid 30 year olds that say things like “it’s 2025 and I’m still filling out forms on a clipboard in my doctor’s office smhhhhh”. 

Then they’ll ask me why that’s the case. People have been treating me like a little court jester healthcare chatGPT house elf for like a decade now. 

So today I’ve decided to answer all the most common questions I get so I can refer people to this post. Below are the questions we’ll be covering today.

• Why can’t I buy healthcare insurance whenever I want throughout the year?
• Why does healthcare still use fax?
• Why do I need to fill out the same form each time I see the doctor?
• Why do teeth and eyes get different coverage?

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Why can’t I buy health insurance whenever I want throughout the year?

Insurers try to avoid people buying coverage right before they need it. If you could buy insurance whenever you wanted, you would only buy it right before you got a surgery you knew was really expensive. You may have heard of adverse selection before, probably when talking about you 😉.

Insurance as a concept only works because there are people paying premiums when they’re not using insurance because that’s used to cover people that do use insurance. Otherwise the insurance company would only be paying money out, which makes it a non-viable financial product. The anti-capitalists are horny just thinking about it.

That’s why if you’re buying health insurance you have to buy it during the open enrollment period. For people buying as individuals, this happens during the end of the year (It’s happening right now you procrastinating f***! This is your friendly reminder to buy a plan!). If you work at a company, it happens during a specific part of the year that’s slightly different for every company.

You also can create an open enrollment window if a life change happens called a Qualifying Life Event. If you lose your job, or get divorced, or move states, etc. Then you have a short period of time to sign up for new health insurance plans and a long period of time to listen to sad music and look wistfully out of a window. 

But once open enrollment ends, you can’t switch or enroll in a new health insurance plan until the next open enrollment.

For what it’s worth, this concept is true of any insurance and not just health insurance. That’s why car insurance and home insurance are mandated right when you get a car/home, otherwise people would sign up right before they made a massive claim. 

Why does healthcare still use fax?

Before Gen Z used it to mean “facts”, faxes were everywhere but still sucked ass to use. They faded over time, but today they can be found in archaeological digs and doctor’s offices.

Fax is still the most widely available way to send information between hospitals. The main reason for this is simple - there isn’t a common standard implemented in a uniform way that exists to communicate information between hospitals. 

An analogy - imagine that Gmail, Outlook, Hotmail (ew), etc. each had a slightly different setup.

• 60% of them used the “to:” field to mean “individual I’m sending the email to”
• 20% used the “to:” field to mean “the text of the email I’m actually sending”
• 10% can't attach PDFs
• 10% don’t have the function to send to people using the other email clients at all

If you want to contact someone, then you’re hoping they use the same email client as you. Otherwise you’d have to send them snail mail, which has a universal standard in the form of addresses.

Fortunately email clients all use the same standard called SMTP. Because all of the email clients agree on the standard and how to implement it, you can send emails to people if you use Gmail and they use Outlook. 

However, electronic medical records have historically not had that agreed upon standard that works well. Standards to transmit information do exist in healthcare - medical records can export giant C-CDA documents, there’s direct messaging capability that actually uses that SMTP standard, etc. But the issue is that many of these are constrained in the types of information you can send, or the receiver needs to have the ability to parse out information they need from the incoming payload. 

There isn’t one agreed upon standard that everyone uses. So when you want to send an ad hoc report or other piece of information, it's often just easier to send a fax. It's the same in every hospital, flexible in what it can send, and has minimal associated costs in terms of implementation and maintenance. 

There’s a network effect with standards - you’ll go to the standard that the most number of people use. In healthcare’s case that’s fax machines.

A lot of people say that fax is more secure than email and is also HIPAA compliant under something called the conduit exemption. I’m not an expert in HIPAA, but when I talk to people much more well-versed it seems like both of these are a common misconception that are untrue. 

But alas, the perception of security + the lack of easy-to-implement alternatives means fax is here to stay. Unless we literally ban faxes the way the UK and Netherlands are attempting (it’s hilariously called Faexit).

Interlude - Courses ending soon

We have a few courses that are starting soon. Remind that all of these courses are virtual and we do group discounts.

The LLMs in healthcare course enrollment ends this week. We have about 5 slots left. We go through real-world deployments of LLMs and how to deal with hallucinations. You can sign up here.

The US healthcare crash course starts 1/28. Taught by yours truly, I’ll explain how US healthcare works over six sessions. You’ll need therapy after, but you’ll understand what your therapist’s bill means. You can sign up here.

The EHR data 101 course is now enrolling for 1/28. Learn why EHR data is so messy and how you can actually deal with it without frantically looking for Judy’s email address. Sign up here.

Why do I need to fill out the same form each time I see the doctor?

When you see a doctor - they need to have the most current information about:

1. Your demographic information
2. Your health insurance
3. Your health issues or any medications you’re on

The doctor’s office has no idea if you’ve seen other doctors since you saw them last, if those doctors changed your medications, or if you got married and changed your name. They also have no idea if you changed your insurance since the last visit. 

This information is key for making sure they get paid for the visit and that they have the most up to date information on your health. So in order to get that, they just ask the patient to fill it out again each time to make sure. On top of that, they have lots of other forms like HIPAA consents, privacy policies, notes about you being on the hook for the bill if your insurance doesn’t, etc. 

More sophisticated offices will ask these using dynamic patient intake forms, which will do things like show your old information and just ask you to confirm that it’s the same.  However, it costs money and time for a practice to implement something like that. And the reality again is that you’re not going to avoid a certain doctor/practice just because you have to fill that form out. 

So, they have you fill out the whole thing again because your time is free to them and patient satisfaction is pretty much optional.

The demographic/historical health data/insurance info might be solved if you had the ability to have all your details automatically filled in with a universal ID that travels with you, similar to how we use single-sign on today with our emails. Why couldn’t we do that in healthcare? Brendan Keeler has written a great post on why identity is particularly bad in healthcare which makes this difficult. 

But this still wouldn’t solve the issue of the doctor needing to know why you’re in the office TODAY. So either way you’re filling a form out, it might just be slightly less stuff.

Even though you filled the form multiple times, clinicians will often double check the answers written in the form when you’re sitting with them. This might seem annoying because you just filled it out and don’t want to spend 5 minutes of a 20 minute visit doing this. Part of this is protocol - you need to make sure the patient being seen is actually the one whose records you have up. And for certain quality measure payments, you need to demonstrate the patient had a given issue in a specific time period so you need to re-ask the question. 

But it’s also important for the doctor to verify all the information is accurate. It’s not uncommon for a patient to misremember a medication they took or something they wrote conflicts with what’s in their medical record. Or their previous doctor wrote something in the record that seems potentially incorrect. 

Verifying information and asking followups as necessary is a relatively small amount of effort that can reduce big avoidable issues. Doctors can also themselves up to a malpractice lawsuit if they don’t reconcile this information correctly.

Why do teeth and eyes get different coverage?

Face holes have different insurance, but why? *FBI knocks at door*

This largely has to do with the origins of dentistry and opticians. Both of these used to be non-healthcare trades and developed separately from the medical field as side gigs. Barbers used to also do teeth work, craftsmen helped create and adjust glasses frames. These fields were largely looked down on by traditional medicine and medical schools rejected propositions to include them as a specialty. Today, barbers that can do a sick high fade have the same respect as dermatologists.

Both fields were largely viewed as cosmetic alterations at the time. Health insurance as a widespread concept started really taking off post WWII and was focused on catastrophic health issues. Dental and vision issues did not fit this bill. So instead dental and vision insurance were created as prepayment plans through employers with the purpose of getting discounted rates. This is basically the opposite of catastrophic insurance, focused on coverage for regular and predictable visits.

This division was really codified when Medicare was passed in 1965 - the government didn’t view vision and dental as a part of regular medical practice so it wasn’t included. At that point, the design of dental/vision insurance was totally different - they were focused on discounted rates and predictable outpatient visits vs. catastrophes. I wrote about how dental insurance works here and vision insurance works here. 

Today, that division largely exists as a historical quirk. You start to see some blending, for example along with medical benefits, almost all Medicare Advantage plans cover vision/dental as supplemental benefits (usually via a partnership with a dental/vision insurance carrier). But most insurers don’t want to have to cover more, because it means they’ll have to pay for it.

Dentists and optometrists aren’t exactly pushing to be included in traditional health insurance either. In fact the American Dental Association has actively fought back against being included in traditional Medicare because they don’t want to be stuck with lower reimbursements and dealing with the bureaucracy that comes with submitting bills to it. Vision and dental currently essentially act as cash pay payments, which are faster and easier to deal with. 

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Hopefully this answers most of your questions. If you have others then respond to this tweet or Linkedin post and I’ll get back to them in a future issue.

Thinkboi out,

Nikhil aka. “I’ll go FAQ myself”

Thanks to Philip Ballentine, Brendan Keeler, and Pryce Ancona for reading drafts of this

Twitter: ​@nikillinit​

IG: ​@outofpockethealth​

Other posts: ​outofpocket.health/posts​

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