Imagine you can't sleep, so you grab your cellphone, open an app, type in "insomnia" and browse a list of specialists. Then you make an appointment with a doctor who the app says has a record of not just being the cheapest but also treating patients of your age and gender.
Maybe then you fall back asleep.
Welcome to Oscar Insurance Corp., a Silicon Valley-backed start-up promising big changes to the cumbersome healthcare industry through its sleek mobile app.
The New York-based insurer, a new player in the Southern California market, plans to offer insurance next month in the individual market on the Covered California exchange, where the four largest companies control 94% of the individual market.
"Innovation, in terms of consumer friendliness, is so far behind," said Glenn Melnick, a healthcare economist and professor at USC. "I am hoping they pull it off."
The company's focus centers around the Internet and mobile applications.
From a computer or the smartphone app, members can type in what they feel is wrong, such as "I can't stop wheezing," which would prompt several conditions to pop up, including asthma.
Another click and appointment options — a free doctor's call or a visit to a primary care physician or specialist — are splashed on the screen with estimated costs. A consumer could expect to shell out a total of $200 in co-pays and typical prescriptions or tests for a visit to a specialist.
Choosing a specific doctor lets you know how often that physician treats patients of your age and gender, as well as the estimated costs you would incur.
Oscar's app or website will also point out which appointment option has proved the most effective, which in the case of asthma is the plan's unlimited free telephone consultations with a doctor who can prescribe medicine on the call.
"Pull up the Oscar mobile app, push a button and a doctor will call you in 10 minutes — no co-pay, no cost," is how Chief Executive Mario Schlosser puts it.
Other features include a free fitness tracker that enables members to earn Amazon gift cards for hitting daily exercise goals. Insurers, including Anthem and Kaiser, offer similar online services, but experts said Oscar's are more seamless and comprehensive.
"I haven't seen anything from an insurer that combines them into one consumer-friendly tool," said Larry Levitt, senior vice president at the nonprofit Kaiser Family Foundation.
Oscar was founded in 2012 by three young Harvard Business School graduates with backgrounds in the tech industry — Schlosser, Josh Kushner and Kevin
Nazemi. At the moment it is operating only in New York state and New Jersey, where combined it has about 40,000 members.
Like many start-ups, the company is losing money — $27.5 million last year — but has raised $350 million, including from a Google investment fund and Silicon Valley venture capitalist Peter Thiel. Schlosser projects Oscar, valued at $1.75 billion based on its private investments, will become profitable in certain markets in 2017 and break even in three to four years as it expands.
In California, the company plans to roll out a marketing blitz Monday. It will first offer plans for singles and families on the individual market in western Los Angeles and Orange counties and will begin signing up members for next year when open enrollment starts Nov. 1. Oscar offers an Exclusive Provider Organization plan, or EPO — a hybrid of the HMO and PPO models. Consumers, for example, receive no coverage out of network, but unlike an HMO they don't need a primary care physician or a referral to see a specialist.
The insurer's Silver plan in west L.A. County — a mid-priced option — carries a $298 monthly premium for a 40-year-old who's ineligible for subsidies. That puts Oscar in the middle of the pack on Covered California, the state insurance marketplace created by the federal Affordable Care Act.
The plan has a deductible of $2,250 and a co-pay of $45 for primary care visits and $70 for specialists.
Providence Health & Services and UCLA Health have signed on to Oscar's network, giving it 16 area hospitals and more than 5,000 doctors.
"We are trying to meet the needs of patients wherever they are," said Brandon Koretz, interim CEO of the UCLA Faculty Practice Group.
Gerald Kominski, director of the UCLA Center for Health Policy Research, praised Oscar's potential to reduce premiums by increasing competition. But he calls Oscar simply "hype" until the insurer can prove itself in California.
"A year from now we will know," he said.
A preview can be seen in New York, where Oscar has offered coverage since 2014. Oscar ranked second out of 12 New York PPOs and EPOs in a quality rating by the New York Department of Financial Services.
Sherry Glied, dean of New York University's Robert F. Wagner Graduate School of Public Service, said that by building its systems from scratch, Oscar has a more "holistic and integrated" online interface than established players. The insurer now accounts for 5% of New York state's individual exchange market.
"Market share is going up and premiums are not going crazy," she said.
For next year, the state approved a 4.54% premium increase for Oscar, compared with an average hike of 7.1% in the individual market.
Jennifer Iannolo, a 43-year-old Oscar member in New York, said she appreciates the ease with which the app accesses doctors. She also likes how it shows how much she's earned in Amazon gift cards from hitting her walking goals.
"I have never had such an easy time with insurance in my life," said Iannolo, who was referred by the insurer to The Times for comment.
Times staff writer Chad Terhune contributed to this report.
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