Breaking the Insurance Monopoly: How FixCare Is Rebuilding Healthcare

Full Episode Transcript

Dan (00:00)
Welcome to another episode of Uninsured by Choice, a podcast where we help you navigate the healthcare system without insurance. I’m your host, Dan, and as always presented by our sponsor, HealthShare, a nonprofit medical cost sharing community. Today we have Karim Waheeb, who has spent over 20 years on the provider side as a physician assistant practicing mostly on the Upper East Side of Manhattan. where he witnessed firsthand how the value proposition of health insurance has shifted for patients and providers alike. That experience led him to confront a persistent reality in his practice, navigating the uninsured and underinsured through the healthcare system without good options. He is the founder of Fix Care, a direct healthcare savings program that gives anyone access to high quality care in New York City and Austin, Texas for less than a dollar a day. So, Karim, welcome to the show.

Karim @ FixCare Direct Healthcare (00:53)
Thanks Dan for having me.

Dan (00:54)
of course. ⁓ Would love to hear a little bit about your origin story over 20 years practicing the provider side. don’t you tell us a little about your experience and background out there in New York.

Karim @ FixCare Direct Healthcare (01:05)
an athletic trainer, so I did sports medicine at the college level and at the high school level before I went to PA school. And then I went to PA school in like 2001, graduated 2001, so it’ll give you a sense of how many years I’ve been at And been practicing orthopedics, primary care sports well as you know, in the OR, we would work in the city where I got to a point where we would rent space from primary care offices and put in little orthopedic then manage 85 % of those patients medically, right? They didn’t need surgery. You could take care of a lot of orthopedic issues, just orthopedics. And then like that 15 % that needed surgery. you know, we had a cadre of different specialists through our network that we would refer those patients to. So we saw, you know, back then, this is like pre ACA, so we had a little bit of like HMO managed care, which was like the first kind of consolidation of insurance where we’d say, hey, we’re in this HMO plan, but the practice is relatively getting capitated money, meaning they get monthly payments from the insurance company. But if any of those patients went out of the network, then they would just penalize you, right? So you wouldn’t get that monthly kind of contribution. So that was like the HMO world, the health maintenance organizations. And then you know, the ACA kind of solidified and that affordable care kind of component. Really what it did was start to centralize practices. we saw the change in the landscape. We’re like, all right, lot of aren’t able to keep their doors open because money that they’re getting from the insurance companies kept decreasing. the cost to keep the doors open increasing, right? So you have this in paying providers, then you have the increase in rent and insurance and the such. And then we started seeing patients with less and less insurance options. They had high deductible plans. They came in uninsured, but they were working. You know, they had a small business or they, know, just elect to go uninsured. And they just would ask, like, you know, don’t have insurance. How much is it? And we had a fee schedule for patients like that. But then trying to get specialty care for them was like, how do get an MRI? How do you negotiate with the labs for blood work? How do someone a surgery? So we started recording all the people we would refer to and kind of figure out what these numbers roughly would be. And we were on that precipice of really taking care of patients that were uninsured but were able to kind of self-insure And this back 2015, 16, 17. It was informal. We just would phone calls, but now up till now, 2026, like we have this whole platform that was built out where we have a network of providers who give us a, you know, either generous discount or something that they can give because everybody’s overhead is different. We don’t really beat people up of what they could afford give as a cash price to the members. But we took away the pain point of what insurance is. Like insurance pain points are, it’s expensive. The premiums are expensive, the deductible is high, so you’re essentially walking around uninsured until you hit your deductible. And it’s difficult to use, and there’s barriers to use it, all these four major points, with fixed care, we display the rate that with membership and without membership, you could see the doctor, and this basically you have a transaction directly with that doctor. and just using us as a platform. We’re not even a fiduciary in between that. We just have the members pay the doctors directly. So this is A to Z so far for this. And what we do care is we market it to small businesses, individuals. New York City, the five boroughs, there’s 183,000 registered small businesses. going after that demographic of the small business, that middle of the bell curve, so to say, because the ends are taken care of, right? lower end is paying, you we pay our taxes for that and they’re subsidized. The other end, well, wealthy, right? So they’re basically legacy wealth and they’re able to pay for those talking about the working middle class that keeps getting, you know, beat up because they don’t make enough money to qualify for state or federal subsidies.

Dan (04:58)
Right.

Karim @ FixCare Direct Healthcare (05:15)
but not enough to cover the burden of a heavy premium, even if it’s partially tax deductible, a huge swap of that. a great complement, Discount Medical Network, for cost because we already pre-negotiated the rates, and you’re getting a better deal at the point of service. opposed to going back and forth and trying to negotiate after the fact.

Dan (05:37)
that’s such a cool story to be able to look at this insurance landscape and how much it has changed because you were there pre-ACA. You were there in the immediate aftermath of the ACA. We’ve had several guests affectionately refer to it as the Unaffordable Care it really did was drive up the costs in a number of ways. So what was that breaking point for you to say, I’m going to start this fixed care network for direct pay to do something about this? What kind of led up to that to where you just this is the breaking point. This just doesn’t work anymore. The insurance, like you mentioned those points, this insurance industry is just broken. We’ve got to do something.

Karim @ FixCare Direct Healthcare (06:14)
COVID, So the ACA happened. led up to ascending to pinnacle of the cliff, And then COVID happened. They basically shut down all the private right? So if you work for a hospital system, you’re still getting paid. But if everybody was staying home and you were a private practice, guess what? You basically shut your doors. weren’t seeing any patients. And if you’re a fee-for-service kind of practice, well, you’re not seeing patients, you’re not getting then the internal medicine practices who we partnered with all consolidated, either sold to bigger entities or sold to the hospital system, got absorbed or absorbed by other insurance companies who have these branches of medical services that are siloed, integrated into their So COVID actually was the eye we all saw it like, basically the stock price of top four insurance companies kept going up and up because they were getting premiums, but they weren’t giving care, especially elective care because no one was seeking elective care for almost two years. the way we practice now that we practice with our partnerships was getting evaporated because we were losing our private practice partners. took a break, did some other work on the occupational health side and back in business school now. But really like the precipice was like when was the actual public outcry the healthcare executive assassinated in broad daylight in Manhattan, probably about like 20 blocks from my the response not a lot of empathy.

Dan (07:37)
Yeah.

Karim @ FixCare Direct Healthcare (07:46)
if you go through the social media, there was an empathy. guy could have been a great guy, like, I didn’t know, but because of his involvement with the insurance company that would deny care the average American who paid their premiums in order to profit from that, like, okay, well, because of the sentiment, need to build new rails, right? Because… the rails currently that are involved. only profit stockholders, a wealth Like we had the chance, they were drafting the Affordable Care Act, we already had existing rails, right? On the federal side, we had Medicare. On the state side, we had Medicaid. could have just expanded let you and I buy If we could buy Medicare, it would cover 80 % of things. And the insurance companies would still make money on the 20%, you know, that wasn’t covered, the supplemental insurances. They could sell supplemental insurances all day, but the bulk of it we could have paid into and utilized it. What would that have done? That would have increased the dollars into the Medicare system and like eliminated the Medicare tax. and the rails were already built. People could get on and register for it. But no. like the insurance lobbies got in and trenched themselves and they built new rails to accommodate and give this kind of project to private sector for them to manage.

Dan (09:08)
I still remember the Speaker of the House, Nancy Pelosi at the time, getting up and saying, we must pass this bill to find out what’s in it. And I thought, more straightforward way of saying we had nothing to do with the creation of this legislation. It was authored entirely by health insurance lobbyists than to say, we have no idea what’s in it, but let’s pass it and then see how it goes. there was an opportunity to really do something like you said. Unfortunately, that’s not what happened and we’ve been dealing with the aftermath for, you know, coming up on two decades at this what’s fixed care? How does it work for someone to be interested in learning about this model kind of is? Because it’s not nationwide, is, in specific areas, others could create something similar if… if you kind of outline just generally how this works.

Karim @ FixCare Direct Healthcare (09:51)
Sure. Yeah, so it’s a dual-sided marketplace where we negotiate cash rates with private practice providers in an area. We build small medical communities, And these are for the uninsured or underinsured, right? So say, you people equate access to healthcare with insurance. So we built access at a really, really low entry point where everything’s transparent, people can use to see it. depending on where your risk tolerance is, it’s going to determine what you get. So if you want a $15,000 bronze plan, you’ll buy that. Or if you want a gold plan because your risk tolerance is low, you’ll pay for that, but you’re paying fixed care, you can just say, all right, I just want access to doctors. at a transparent rate that’s best in class and I can get in. they worry about the other stuff. So to kind dismantle that, like, yeah, and anybody that’s an operator has like a good referral network or primary care doctors, old drug reps that had territories, like anybody can build this. The issue is that we lost 80 % of private practices in CACA, like 20 % still practice independently. They’re hard to find. fixed care, now what we did was we built a network of independent providers that are like-minded, that now could refer to each other. Because what happens inherently, if you’re a primary care doctor, you can’t find an endocrinologist, you send that to the hospital, guess what? Like the that patient, silos them within their primary care, very rarely do independent providers in the community will get referrals from the hospital. Never happens. They silo that in, it’s all built in, they extract it. So with fixed care, now you have a network of independent doctors that can all refer to each other. So we keep that kind of like, independent, patient-centric, keep costs down, we let the patients know what…

Dan (11:28)
That’s incredible.

Karim @ FixCare Direct Healthcare (11:41)
cost before they utilize feedback is really great. We’ve got a few dozen now on here. We just went live probably about nine weeks ago and getting good adoption. And people like the feedback. Like right now, I’m patient concierge. If they have questions, it’s me now. But it’s pretty self-explanatory on the site. And people are able to get in. got our providers ⁓ able to verify the members if they’re active or inactive when they come in, because we show the prices. if you want to go on the website, you can say, all right, I need to see a primary care doc. Five of them will pop up and all of them have different prices. Go down the road and see which one sees you first, you know, and the prices are And they’re low volume, you know, independent docs. So it’s a great experience for the vast majority of people that use it.

Dan (12:31)
Yeah, I like that. it works on both ends. So for patients looking for care, you get this membership to fix care. And now you are sort of in this network style of a group of, of doctors who all have cash pay rates or even, even discounted beyond the regular cash pay rates in some cases, it sounds like. But then if you’re a provider, you now have a confident referral network of sorts, because you don’t want to refer to these.

Karim @ FixCare Direct Healthcare (12:51)
So,

Dan (12:59)
big, huge integrated verticals, hospital systems where it’s, they’ve got everything in there. You send a patient to, like I said, an endocrinologist, a urologist, any specialist, and now they’re in that network. They will never come back to you and you’ve solved for that as well. So it really works in both sides. And the beauty of it is there’s

Karim @ FixCare Direct Healthcare (13:02)
thank

Dan (13:19)
no insurance involved. It just says, this is what things cost. That’s getting back to that true sort of free market. principle that America’s really founded on, which is that competition is a good thing in the marketplace. And that’s what healthcare really lacks is that the insurers hardly compete with each other. The providers are hardly competing with each other. They’re just trying to own as much of it as they can. So they don’t have to compete with each other. by creating the solution, I think you’ve made a really clever way for people to navigate their healthcare without insurance in a way that works for both patients. and providers.

Karim @ FixCare Direct Healthcare (13:55)
Provider-centric, like how do you build a healthcare product or network or philosophy? that benefits patients and providers. Like you’re either a patient or you’re a provider, right? Like building a third entity in there just value So yeah, thank you. Yeah, that’s basically in a nutshell. the back end, you know, we partner with, you know, health shares and medical cost shares. So we partnered with two at one of them are Zion. know, we give people that option where it’s like, you know, explain to them fixed care is great for about 85 % of the things that are outpatient. But if there’s an unexpected hospital event or an unexpected surgery, you want someone in your corner with some kind of you know, well of money to help. And so I always liked the philosophy of cost shares in that manner because it’s more community driven it’s not insurance. It’s a misnomer that we think insurance is always going to cover us because in practice, and we’ve heard all the stories. Physicians that order treatments or tests that are either life-saving or needed for electively are constantly denied, when your business model is taking premiums, manages premiums and less than you take in order to increase your stock price, that’s a problem. you have a, a… disjointed incentive process that has nothing to do with the provider or the patient, has everything to do with profits. cost sharing basically puts that member at the forefront of that because even though not regulated by insurance regulators, are highly sensitive to the Better Business Bureau. They are highly sensitive to any kind of negative connotation towards those specific entities and they do in my experience everything that they can do to make that patient hold that member everybody’s happy so they keep being a contributing to the program you’re disgruntled insurance, know member they could care try to see them They have 20 attorneys sending cease and desist letters all the try to complain about them They don’t care if you complain about it because their stock price or you know

Dan (15:52)
Yeah.

Karim @ FixCare Direct Healthcare (16:05)
doing gangbusters. I mean, there’s a lot of bad press for a couple of the insurance markets now, but because with Medicare know, increasing their rates, all the stock insurance, you know, stock prices went up, you know, about 13 % over the past few days. taxpayer dollars being given to directly entities. Our tax dollars go right into that, even though we don’t use So we’re in a mechanism where the middle class pays the most in taxes to subsidize these products, but use it the least because they don’t qualify for state or federal it’s an interesting kind construct as far as a wealth extractor that’s going on right now, the American populace, especially the taxpaying populace.

Dan (16:30)
Yep.

Right. you can sort of view any industry or company as a wealth extractor or wealth generator or anything like that. when it’s based on life and death, that just doesn’t seem like the kind of thing that should be driving anyone’s and you look around the world, other developed nations don’t all treat it that way like we do. They do treat it like a life and death situation. Say, you know what? We really shouldn’t hold people’s feet to the fire here because What choice do you have? I want to live, not die. So I’m going to do whatever it takes. And when you feel pigeonholed into this, everyone has to get insured, which like you said, doesn’t even amount to much anyways, with all the denials that are out there. But I like how you talk about pairing, something like a fixed care with a health share something else like that. It really is all about,

Karim @ FixCare Direct Healthcare (17:15)
Sure.

Dan (17:33)
less about being a passive spectator when it comes to your healthcare and more about being an active participant and saying, I’m actually going to vet out the people that these potential providers, you when I moved to a new place, I’m not just going to go say, who’s the nearest doctor? And there I go, or call my insurance. Who’s in network? They are great. I’m going to go there. No, you’ll actually see. what the reviews might be, what the prices might be, what the options are, and then say, no, actually for me and my care and what I need, this doctor is gonna work a lot better than that doctor and I shouldn’t be told by my employer, by my insurer or anyone else that I have to go see the doctor that I don’t want to see. I should be able to choose that. And that’s what we’re doing with health sharing, with fixed care, care and direct pay, that whole ecosystem. So how do you see this evolving? You’re new, you’re small ⁓ so far, but how do you see it evolving and expanding this whole direct care and direct pay ecosystem across the country?

Karim @ FixCare Direct Healthcare (18:35)
the issue is that like there’s no change in the All of this noise we got out there, there’s no real change unless you have lobby as long as there’s health insurance lobbyists and they’re able to basically contribute to politicians who are the decision makers to policy, like nobody’s lobbying for the American people, right? So even if you say, ⁓ I’m going to lobby with my vote, you’re getting the choice of two people in most parts of the region are definitely both getting contributions from the lobby, the same lobby. have to make new rails. this past year was the turning point conversations with people that run these cost shares or are on the sales side, they’ve had, badder years this year. because of the messaging and the loss of the tax credits and changes in healthcare, care has been more popular. With health shares, you can go and say, you know, yeah, there’s no network, great. But you still have to go and negotiate those rates or ask what the cash price is and make sure it makes sense. We already did that.

Dan (19:32)
Right. Yeah, the direct, the whole direct ecosystems and just direct directly pain for direct care, but direct everything, just knowing the sources of, food, your information, you know, there’s so, so much misinformation online too, people will say, well, this is healthy. No, that’s not healthy. This is, and well, which is it? the complexity of it all that that layer that insurance adds. just makes it so that I think people throw up their hands and just say, don’t know, I don’t know. We’re all going to die. We’re all going to get cancer. We’re all going to die at some point. So I’m just going to enjoy it while I can. And this defeatist attitude that is so prevalent online these days.

Karim @ FixCare Direct Healthcare (20:11)
And there’s that. Yeah, and then the biggest

Dan (20:17)
Everything about healthcare, medical, just health in general. it’s, it’s tough to navigate, but it’s always nice to see people who are doing something about it. That’s what we’re trying to do on the podcast and in our own way. thanks again for being on the show today. Remember you can subscribe on YouTube, Apple and Spotify and we’ll catch you all next time.