Three weeks in and here’s the uncomfortable truth: We have no idea what’s actually broken.
We can see claims. We can see what processed. We can see what got paid.
You know what we can’t see? Everything that failed before it became a claim.
The prior auth that’s been pending for weeks? Invisible.
The appointment that didn’t book because the provider said they aren’t in-network? Invisible.
The prescription someone gave up on after the pharmacy rejected it twice? Invisible.
The physical therapy that was skipped because the copay was $75? Invisible.
Claims data only shows us successful transactions. It doesn’t show us all the ways the system failed before there was ever a claim.
And that’s a massive problem.
Healthcare Has Normalized Failure
Here’s what people say when things break:
“Oh, prior auth takes 3 weeks? That’s normal.”
“The directory is wrong? Just call every office.”
“My $10 copay was actually $50? Must have read it wrong.”
“I gave up trying to schedule that appointment? Yeah, it was too complicated.”
NO. None of that is normal. That’s all broken. We just collectively decided to accept it.
Every industry has bugs. But healthcare is the only one where we treat bugs as features and then gaslight people into thinking they’re the problem.
“Did you call the right number?”
“Did you check the provider’s directory?”
“Did you read page 847 of the benefits guide?”
How about no. How about the system should just work.
The Stuff We Can’t See (And Need People to Report)
Things that show up in claims data:
- Doctor visit → claim filed → we see it
- Prescription fill → claim filed → we see it
- ER visit → claim filed → we see it
Things that DON’T show up in claims data:
- You tried to schedule with 5 providers who all said they don’t take our insurance (even though the directory says they do)
- You’ve been waiting 2 weeks for prior auth on a medication you take every day
- You paid a $40 copay when the plan says it should be $15
- You drove to a different pharmacy because the first one said your prescription wasn’t covered
- You looked at the specialist copay, said “that’s insane,” and just didn’t go
- You filled out the same form four times because nobody told you it was already on file
All of that? Completely invisible to us.
We’re flying blind. We only see the claims that successfully made it through the obstacle course. We don’t see everyone who gave up halfway through.
The Hidden Nonsense We REALLY Need to Know About
But here’s what we really want to understand: How does this plan actually work in the wild?
Because plan design looks great on paper. Then real humans interact with it and suddenly nothing makes sense.
Examples of things we want our employees to report:
“I went to urgent care. They told me my copay was $100. I paid it. Then I got a bill for another $200. What did I actually pay for?”
“I tried to get physical therapy. The copay is $30 per visit. I need to go twice a week for 8 weeks. That’s $480. So I just… didn’t go.”
“My prescription was $10 last month. This month it’s $80. Same prescription. Nobody can tell me why.”
“I called to ask if a procedure was covered. First rep said yes. Second rep said maybe. Third rep said I need prior auth. Which is it?”
This is the stuff we need to know.
Not just “the system is broken” – but “the system is confusing and I made a decision based on that confusion and maybe it was the wrong decision.”
What Is Coverage Stack Overflow?
We’re launching a bug reporting system for our employees. Email: overflow@zero.health
When our employees hit something that feels broken, confusing, stupid, or nonsensical? We ask that they report it.
What we need:
- What happened
- What was expected
- What was actually paid (if anything)
- Was a healthcare decision made because of cost/confusion
What employees get:
- Near immediate acknowledgment
- We investigate what actually happened
- We figure out if it was wrong (and fix it)
- We figure out it was “right” but confusing (and we’ll make it clearer)
- We document it so the next person doesn’t hit the same confusion
Why This Matters More Than You Think
Traditional health plan approach:
Look at claims data once a year. See that costs are high. Raise premiums. Blame “utilization.” Never ask why people aren’t using or can’t use the plan correctly.
Our approach:
Find out why people aren’t using the plan correctly. Fix the confusing parts. Fix the broken parts. Fix the nonsensical copay structures. Make it actually work.
But we can’t fix what we don’t know about.
Maybe the plan is designed wrong. Maybe the copays don’t make sense. Maybe we’re accidentally discouraging the exact care we want to encourage. Maybe the communication is terrible.
We can’t see any of this from claims data alone.
No Complaint Is Too Small
“I don’t want to bother you with something minor.”
It’s not minor. It’s data.
“I figured it out eventually, so it’s fine.”
It’s not fine. If you had to “figure it out,” it’s broken.
“That’s just how insurance works.”
No. That’s how insurance has worked. It doesn’t have to be that way.
What We Need From the Public Community
If you’ve worked in benefits, you know what never shows up in claims data:
- What copay structures accidentally discourage preventive care?
- What plan designs look good on paper but confuse everyone in practice?
- What communication gaps exist between “what we think we explained” and “what people actually understood”?
- What cost-sharing structures make people avoid necessary care?
Tell us in the comments. Help us avoid the predictable failures.
What Happens Next
Starting today:
- Employees at ZERO can email overflow@zero.health with anything that feels broken, confusing, or nonsensical
- We investigate every single one
- We fix what’s actually broken
- We clarify what’s confusing
- We adjust plan design based on what we learn
Coming soon: The first wave of bugs – what we found, what we fixed, what we learned about how our plan actually works in the wild.
Stop accepting nonsense. Report the bugs. Help us understand what’s actually happening out there.
