As reported on October 5, 2016

Dan Polsky was a bit skeptical when he heard the news that, after a 10-story fall and a week-long coma, construction worker Kal Mathyssen had awakened with the ability to fully understand his health insurance policy. So Polsky decided to give Kal the ultimate test: could he describe the breadth of the provider network in his insurance plan?

Polsky, who has spent the better part of the last four years trying to compare networks to T-shirts, is skeptical no more. “Really, I thought I had the perfect test…what could be more incomprehensible than provider network size?  Who even knows what that means?”

Kal, a burly man with an unusually large neck, laughed as he recounted his conversation with Polsky. “He asked me the simplest questions, and seemed shocked when I knew the answers. Like, what percentage of hospitals are covered by your plan? What percentage of doctors? What’s the trade-off between premiums and network size? I mean, seriously?”

“So I had to explain it to him, in ways he could understand. My policy has an extra-small hospital network, except it includes the essential community provider across the street from my house. I save 17% of the median silver plan premium that way. Plus it has an extra-small primary care provider network, and I save an additional 7% of premiums, which works for me because I never get sick.  But it has an extra-large network of surgeons, because when I fall, it’s a long way down…”

Polsky confirmed that Kal’s understanding of his policy far exceeded that of Polsky himself. “Kal had the uncanny ability to measure networks by breadth and distance, taking into account traffic patterns and topography. He adjusted the size of his hospital network by the proportion of out-of-network anesthesiologists and pathologists that he might encounter in a hospital visit. Further, he calculated the deductibles, copays, and disallowed charges to the penny. He represents a natural experiment in how perfect price transparency could influence health plan decisions.”

“By falling out of a window, Kal has opened up a new window on the human capacity to understand health plans,” Polsky added. “I’m excited by the possibility that health plans could create even more complex products that could fit customers to a tee.”