Empowering patients to submit reimbursements through a mobile app
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Getting Coverage for out of Network Care with Bill Brown, Founder and CEO at Reimbursify was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text. Our automated transcription algorithms works with many of the popular audio file formats.
Welcome to the Outcomes Rocket podcast, where we inspire collaborative thinking, improved outcomes and business success with today’s most successful and inspiring health care leaders and influencers. And now your host, Saul Marquez.
Saul Marquez:
Welcome back to the podcast, Saul Marquez here today. I have the privilege of hosting Bill Brown. He’s the founder and CEO and Industry Disruptor at Reimbursify. He co-founded and launch Reimbursify as a new and highly disruptive, app centric, platform based solution, enabling consumers and health providers to easily file for their out-of network health insurance reimbursement with a smartphone. The industry in the way that they handle this, particularly with PPO insurance, is pretty antiquated. But Bill and his team have found the way to make it easy for both the insured as well as the health care providers. So it’s going to be a great conversation today. Bill, so glad you joined. Thanks for joining.
Bill Brown:
Hey Saul great to be with you today.
Saul Marquez:
So, Bill, I love that you guys decided to tackle this area before we dive in. I want you to share your story about your personal experience and the fax machine. And then let us know a little bit about what inspires your work in health care.
Bill Brown:
Sure. I’m happy to do it. Yeah. So, you know, I think a lot of great startups sort of catalyze from personal experience. And what happened with me along those lines is my co-founder, who is a trained physician. Kib originally conceived of the idea and brought it to me. So his background is on the clinical side, although he’s incredibly technical and my background is on the technology side and so he brought this idea to me. We’ve been friends for 4 or 5 years beforehand and it just completely resonated with me because it just so happens that my wife is a mental health professional. She’s been practicing Right., a private practice here in Greenwich Village for over 25 years and never taken insurance. So I understood the problem around out-of-network health insurance reimbursement from the provider side. But I also have 2 young adult daughters who avail themselves of out-of-network services. And so I tend to be the person in the family who files for it to get those reimbursement claims. And what had happened was one of my daughters had done and gotten some out of network services. I had filed a series of claims for that with our health insurance company and forgotten about it about 6 weeks after I mailed those in, my wife asked me what the status was, so I called the insurance company, they told me they’d never received it. I needed to send it in again. So I went. I repackaged it, another copy, sent it in with tracking. I got the tracking response, the signature saying this was accepted by Sam Smith at this date, at this time at our processing center and then I forgot about it again for another 6 weeks and then called them and they said, we haven’t received it. We don’t have it. And I said, well, I know you received it because I have Sam Smith signed for it. And they said, well, you may have that, but we don’t have it in our system. So you’re going to have to send it again. And I said, I want to fax it. And they say, we don’t accept fax. You have to send it into the mail. So this is the 21st century. And how many things do you have to send them through the mail? So I got a little indignant. And I said, I an incredible amount of money for this health insurance every year. So I want to talk to somebody who can help me get this resolved after the course of probably close to half an hour, finally was able to speak to someone who said, OK, Mr. Brown, we will give you a one time exception. We’ll give you a fax number. You can use it one time and one time only to rescind these claims. And so I did I was very pleased, hung up the phone, went to the fax machine, sent the fax, dialed the number, which, of course, was busy. The fax machine continued to redial the number over the course of two hours. It was busy the whole time and then it quit. I went to work, came back that night, tried to send it again, same scenario. The next day when I got back from work, I reprogrammed the fax machine to dial the number continuously until it connected for ever. And I was so frustrated that I said, When you do it, when it does connect, please send 100 copies of this claim. So the next morning I woke up and at 4:37 it had connected and it said 100 copies successfully sent. And lo behold, my insurance company sent me the reimbursement check and they never they never lost another mailing that I sent to them. But I knew the pain. I had spent literally hours trying to resolve this issue, which should have just been really simple to do. And that’s really what the Reimbursify app solution does today. It enables the hundred and 20 million people who have out-of-network health insurance benefits in this country to submit a optimized out-of-network health insurance reimbursement claim from their phone in under a minute.
Saul Marquez:
Man I mean that right there is value. So I totally understand what inspired your work in this business. You were frustrated as many of us are frustrated when it comes time to deal with insurance companies and they do a lot of good but there’s a lot of opportunity for them to do things better. And so love what you have done here, Bill. And so what would you say is the core thing that you’re offering people? And what is the cost for somebody using this, whether it be an employer listening to this or an individual?
Bill Brown:
Sure. So the core thing is, is efficiency an optimization, so we create a mechanism that’s really makes it very very easy to file for that reimbursement that everyone is owed. If you’re paying a thousand dollars a month or 2 thousand dollars a month or 3 thousand dollars a month for an insurance policy for you and your family, that insurance policy the reason why you’re paying that amount of money gives you the ability to see healthcare and mental health providers who are not associated with that health insurance companies network. That is why you pay a premium. You or your employer pays a premium for that insurance plan. So we’re really creating a way to reduce the total out-of-pocket spend for the patient and the consumer while creating and optimizing effect for providers and patients as well as employers who are invested in the well-being of their employees.
Saul Marquez:
Yeah, it’s a really great great option and it’s an app. So tell us a little bit how to interface with it? How does an employer offer this to people? How does an individual start using it there? Can you walk me through the logistics there?
Bill Brown:
Absolutely. So we sort of see this as 3 different stakeholders across that spectrum of health insurance reimbursement. And that is the the subscriber who is effectively the patient and their families. In that scenario, anyone can go to the app store today and download the app for free. Just do a search for Reimbursify, you download the app for free, you file your first claim for free. And then after that, it’s about 2 bucks to claims, a dollar 99 to claim, for subsequent claims.
Saul Marquez:
That’s it.
Bill Brown:
Yeah, that’s it. We actually have a lower price point because the app, if you file multiple claims, which is very common in a single setting, the app will give you the option of buy to buy a 10 pack of claim credits or 1499. So it takes it actually down to about a dollar and 50 cents per claim. On the provider side, we have a couple of offerings, the first offering is sort of on the high end of things it’s called joining Reimbursify as a provider pro. What that means is a provider you’ll pay us a monthly subscription fee which is currently about 99 dollars a month, although we do have some promotions around that and maybe through your podcasts we’ll we’ll share some special promotions for your audience, for your provider audience. And basically what we do is we are syndicate the practice within our software platform that underlies the app, and that way providers can offer the app to their caseload as a concierge service. So a patient comes in to see a Adam network provider, a cash paid provider, mental health provider. Perhaps you have the session, you get the service, you pay the provider, and then the the provider would then give you a receipt and then they would give you Reimbursify information card and they would say, here you go, download this app and you can file your reimbursement claim at no cost to you with my compliments. That’s called being a provider pro.
Saul Marquez:
And that’s 99 bucks?
Bill Brown:
99 dollars a month for this year. That’s per practicioner. If it’s a group practice, we have some discounting tiers,.
Saul Marquez:
But still very reasonable.
Bill Brown:
Very reasonable because it completely outsources all of the insurance issues, all of the out of network insurance conversations. And what the thousands of providers that are using it today are telling us is that it’s helping their practices grow. It helps their practice grow in 2 ways. The first way is with those around new patient acquisition. So when a new prospective patient finds out about a provider, say, through a Google search or even a personal referral, they’ll typically call that provider’s office and they’ll say, I’m interested in coming to see you. Tell me a little bit about your practice, whatever it might be and somewhere in that conversation, they’ll say, do you take my insurance? If you’re an out of network provider, historically, the answer has been, no, I don’t take your insurance but I’ll give you a receipt and you can talk to your health insurance company about that. You may have some reimbursement benefits that you can deal with, with Reimbursify, now the script changes. So the prospective client says, do you take my insurance? And the provider says, well, I’m not affiliated with any insurance networks. However, I will give you an app and you can use that app to sell file for your reimbursement claim in under a minute. So you’re really shifting that paradigm from a No to I’m going to give you a solution. And so providers are telling us that that initial patient conversion rate jumps by 20 percent for them. And then, you know, in the long run, patients who are getting reimbursement for out-of-network services tend to engage in more out of network services. They book more regular appointments. They don’t feel constrained by an insurance network. And so it’s just a win win win for everybody. So the other alternatives on the provider side is we offer a secondary tier where you can offer Reimbursify to your caseload and it only costs you 49 dollars a year. And in that case, we send you special information cards and we give you a promo code that lets your patients get their first 5 claims for free. So you can say for full for 50 dollars a year, you can say, here you go. You get your first 5 claims for free with my compliments. So oftentimes that’s again, another great service at a reduced cost to the provider. And then ultimately, if a provider doesn’t want to pay anything, then we we do offer sending them small sort of business card size information cards they can hand out at no cost. And then the their patients download the app and they get their first claim for freedom and the rest goes on.
Saul Marquez:
Then you go to the consumer model instead.
Bill Brown:
Right. So that’s sort of like consumer provider and then third the third channel that our platform supports is employers. And this is something that’s relatively new we just announced that a couple of months ago. We’ve already regicide our first clients. Thank you. And that is called Reimbursify enterprise. Well, Reimbursify Enterprise does is it uses those same software platform mechanisms to authenticate a company or a department within a company or a division within a company. So now employers can add Reimbursify as an add on benefit to their existing health insurance benefits. And where we’re seeing a great deal of response and sort of resonance around this is in mental health. So mental health access is a real top of mind issue right now with with H.R. companies sort of across the spectrum and in across the country. Mental health, bless you. Mental health practitioners who are out of network are 50 percent of all mental health professionals. So fully half of all mental health professionals take no insurance nationally in large metropolitan areas like New York, Los Angeles, Dallas, Chicago, Seattle, 70 percent, it’s 70 percent of mental health providers don’t take any insurance. And so if you’re looking for an in-network solution, only 3 out of 10 providers in your geography are going to take insurance and only a fraction of that are going to take your insurance. So while we’re communicating to companies is that if you give Reimbursify Enterprise to your employees, you suddenly open up access to 100 percent of all mental health practitioners within their local geography.
Saul Marquez:
So, let me, let me ask you quick question there, then. So there’s many in this particular instance in the urban area, 7 out of 10 don’t take insurance, which I Reimbursify, You would be able to get coverage?
Bill Brown:
Yeah. So if you have a if you have a PPO insurance and so you if you have out-of-network benefits, which the vast majority of individuals who get their insurance through their employers choose to have, then you can go see an out of network provider, a provider that is not associated with that health insurance company. And you can get some insurance benefit from that. So practically how it works in the real world is most insurance plans have some level of deductible where, you know, you’re responsible for the first amount it might be 500, it might be a thousand, might be 2 thousand. So you have to go, you will have to fulfill that out of network deductible. But will we see all the time is people who think that they’re not going to say, oh, I’m not going to file. I never filed an out of network claim because I have this deductible. If you look at it over the course of the year, they so sale their deductible. And if you are engaged with some sort of repeating health care or mental health treatment, it could be regular psychotherapy. It is it’s it could be seeing a psychiatrist once every other month. It could be having an injury and then going to a physical therapist and having a series of sessions. Those things fill up a deductible very quickly. And then suddenly you’re getting checks mailed to you from an insurance company. And I can tell you that getting a check in the mail from your insurance company is a transformative experience. Yeah.
Saul Marquez:
What is this? That’s incredible.
Bill Brown:
That’s one of our one of our early, very early investors. The company had that experience where we had that we had built out the initial prototype and sort of NDP of the product, and we were giving it out to a handful of people while we were doing some fundraising and one of the investors said, you know, I have some out of network claims. Can I try the app? And we said, well, cause so we sent him a version of it to download test. That’s right. Exactly. And he downloaded it. And we continue to have conversations. And it was just sort of like great conversations, but we weren’t moving to closing a deal. And then we were about it was about a month later he called me up on a week and it was a Saturday. And he said, Bill, I just got back from the gym and I opened my mail and there was a check for 6 hundred dollars from my insurance company. I’m in. So he says…
Saul Marquez:
6 hundred plus.
Bill Brown:
Yes, that’s right. Exactly. But he recognized he recognized that, you know, that’s really an amazing thing. And the truth of the matter is all that the belief is reimbursed by the entire team here, so dedicated to this concept of helping people claim their money back, because the healthcare system today is people are completely financially saturated. You cannot you pay so much for health insurance and then you have co-payments and deductibles and then co-insurance. It’s just completely saturating. So if someone can get a thousand dollars back or 10 thousand, we just recently had someone who has a family of 5. He sent us an email telling us that last year he got back over 18 thousand dollars. Now that’s on the high end of the spectrum.
Saul Marquez:
Now, I would imagine, yeah.
Bill Brown:
Thousands and thousands of people who are getting anywhere from a few hundred to a few thousand dollars back. And it’s such a positive impact on them. So we’re really we’re really so excited every day to come in and try to make a difference.
Saul Marquez:
That’s awesome, Bill. What a great model. So there you have it, folks. You listen into this. You’re like, wow, I have a couple out of out of network things that I could be covered for now. Is it retrospective? Can you do it retrospectively?
Bill Brown:
Yeah, that’s a great question, that’s a really good question. So the short answer is yes. So you can you can back file in and it’s very, very common. And we’ve built the app in such a way so that you can go into a claim filing session and you can back file dates for repeating visits such as a psychotherapy visit or a physical therapy or an acupuncture or some series of events or whatever it might be.
Saul Marquez:
Oh, acupuncture too?
Bill Brown:
Anything that generates a medical code is reimbursable. So we have we have a lot of acupuncturists, because…
Saul Marquez:
Yeah my wife, my wife does…
Bill Brown:
Acupuncturists are out of network. And so those are the kinds of things that fulfill a deductible very quickly. And then you start to get reimbursement.
Saul Marquez:
Yeah, yeah, yeah. Because it’s consistent. Right. you keep she keeps going and it’s a box every time, etc.. Yeah. Wow. Ok.
Bill Brown:
Exactly.
Saul Marquez:
And I’m gonna do some retroactive ones here man.
Bill Brown:
I’m going to send you a special promo of a sudden.
Saul Marquez:
Allow it.
Bill Brown:
And make it even easier for you but the truth of the matter is that how far back you can file is dependent on your individual plan. So.
Saul Marquez:
Oh yeah I got you.
Bill Brown:
It used to be that you could file back a year without any problem. Many insurance companies today are trying to close that window. And so they’re saying a hundred and 80 days or 6 months is the sort of window that for sure you can file in. That said, you know, we have people that file back as far as a year and get reimbursed all the time.
Saul Marquez:
That’s a big one because for everybody listening right now, you’re like, I wish I would’ve known. Well, guess what? You could go retroactively 6 months to a year. It’s worth a try, especially since the first one is free, right? I mean, that’s sort of a no brainer. And even for your employees. Right., maybe you’re on a larger scale and you’re thinking, man, how many out of pocket am I dealing with this stuff? It’s a cool solution. So something to consider. Go to the app store, Reimbursify and you’ll find the app, but also online Right, Bill?
Saul Marquez:
Where where can contact you online?
Bill Brown:
The sole provider should come to Reimbursify.com, and you can click on the I’m a I’m a healthcare provider and they can register their practice with reimburse defi and then they can choose if they want to become a provider pro and have all of their clients and patients file at no cost to their to their case. So they can offer that if they want to offer 5 free claims to their each patient or they just want to recommend it and completely not have to deal with it. And you know, we have providers that email us every day saying thank you, because now when somebody comes in and says, I’m having trouble getting this claim, reimburse my insurance company, what do I do? Now they say just send an email to hello at Reimbursify.com and their customer care team will take care of it. I’m going to go see my next patient. So it completely unburdens the provider and on the provider side, what we’re seeing is, again, around that whole paradigm of people are like really thinking about how much they’re spending on health care and they’re trying to use out of network and get reimbursed. And they’re having issues. They’re going to their H.R. team and they’re going to their human resources group and saying, help me with this. And that’s the H.R. professionals. And most companies, their plates are full with dealing with all sorts of ongoing issues. And they’re not trained. They don’t know. They don’t understand the health insurance reimbursement and adjudication eco system. So it becomes frustrating and ineffective. So when you sign up for Reimbursify Enterprise, you’ll pay us a per employee per month feeds very low and then you give it to your employees and we take that burden off. Your employees are happier. Tons and tons of research show that providing mental health access to your employees results in tons of our ally. It reduces absenteeism, it reduces addiction issues. It enhances personal productivity and team cohesion. So it’s just all good.
Saul Marquez:
Now, this is great. Well, Bill, this has been awesome. The conversation around being able to get covered out of network is, I think, a hot topic for everyone. And so I appreciate the work you and your team are up to before we conclude. I love if you could just share a closing thought. And the best place where people could connect.
Bill Brown:
Sure, sure, I appreciate that. Well, first of all, thank you so much for this opportunity. So awesome to meet you. And I’ve been listening to your podcast for a while. It’s always insightful. And you get perspective from your guests in a way that is hard to find somewhere else.
Saul Marquez:
Thank you.
Bill Brown:
The overall mix is really amazing. We’re just really excited to continue to get out there and let people know about this simple solution that’s available to them as patients, as providers and to their employees, as as executives and companies who are looking to really draw the best talent and retain the best talent through the most comprehensive benefit programs and enhance the overall productivity of those teams. You can reach out to us. Just go to Reimbursify.com, You can get everything you need there. You can find us in the app store if you want to. Download the app and use it yourself. And really looking forward to 2020 and starting to really drive the adoption and help hundreds of millions of people claim their money back.
Saul Marquez:
Love it, Bill. Keep at it. And I really appreciate all the things that you’re doing for us.
Bill Brown:
Great, Awesome. Thank you. Saul.
Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes, resources, inspiration and so much more.
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