Road to recovery: Self-funded care cuts through the noise

Part 3 in an ongoing series about MSK conditions and how advisers are changing their approach to treatment with new benefit solutions. 

For these advisers, finding care was just one part of the process — paying for it became yet another exercise in utilizing benefits and their extensive healthcare knowledge. 

Toward the end of January, Apta Health's Joey Stone, who had spent months in pain due to stenosis, had a laminectomy that instantly erased intense pain that was nine on a scale of one to 10 and was recently cleared to work out again at the gym. But it was a challenge to even secure that procedure. "The surgeon was not going to see me because I was cash-pay," he reports. Once that surgeon understood that he was actually going to get paid before the service was provided, though, he was so ecstatic that the surgery was moved up two weeks because Stone was in so much pain. 

He was able to benefit from a self-funded program his company offers to finance 100% of claims as a cash payer. Stone and employees who use his service are provided a debit card that is loaded with funds to pay medical bills at the point of service. Another option is to pay by voucher the day before treatment. 

"We negotiate cash payments prior to the service," he explains. "It's like reference-based pricing, but there's no balance billing and no shock to the provider, and we've saved members the agony of collection calls."

Read part 1 of the series: Road to recovery: How MSK conditions transformed advisers' approach to benefits and care

Recovery at last

While in the recovery room after surgery, Contorno noticed his pain was instantaneously gone. The only lingering effect since then has been some tightness in his lower back, which the surgeon said was his body compensating for miserable leg pain for almost a year. 

"I have so much more respect for people who are in chronic pain than I did," says Contorno. "It is mentally and physically draining. It is a burden on your family, employees and everybody. So, I can understand why people go right to surgery."

Testa reports that he's thankfully pain-free 99% of the time, doesn't take any meds, works out full time and no longer travels on an airplane with a pillow. "I've seen conservative treatments like steroids, epidurals, PT and ablations — and they just don't work for long," he says. "They don't work well when they do work, and you can't undo surgery."

Read part 2 of the series: Road to recovery: Are non-surgical remedies the solution to MSK?

Silverman's pain was over the second he had surgery. "I am back to better than normal. I feel amazing," he says. "I've been in the industry for 25-plus years and going through that experience was mind-numbing. Most people just don't have the ability to do what I did."

Humbled by his incapacitation and having weathered a few emotional and mental breakdowns, Stone began to re-evaluate life and doubled down in his resolve to help fix the healthcare system for others who will walk his MSK path. 

The misalignment of incentives, whether it's for a hospital, specialists or in the pharmacy benefits management space, continues to fuel a profit-centric system for providers of care, he believes, adding: "I think cash-pay cuts through all that."

Part 4 of this on-going series will be live Wednesday. Catch up on Part 1 and Part 2.