Health Insurance · Health Systems

How can a healthcare provider startup easily set up billing with insurance payers?

Adam Signaigo Available advisor :: Experienced operations, product, and services leader

March 27th, 2018

Looking to understand existing or tested approaches to enable an ecommerce platform for healthcare supplies to apply customer insurance to online sales and bill back the insurer (from the wide array in the US) - assuming coded properly and approved.

Aleksandra Czajka Freelance Senior Software Engineer, Developer, Web Developer, Programmer - Full Stack

Last updated on March 29th, 2018

Adam,

An interesting problem to tackle!


In my experience working with third parties, you will need to have discussions with individual insurance companies in order to see whether they will allow you to do this. You won't really be able to bill them unless they know your platform and that the bill will be coming. With that, it will all depend on each individual insurance company. That's not a problem as in your MVP you can get started with a top few or the few that will work with you, prove the concept and convince the others that they need to work with you as well based on the success of your MVP.


After you have a few insurance companies it will all depend on the techniques they are most comfortable with. Do they open up any sort of APIs to allow you to do this? If not, how would they like to get billed? Are they working with a straight forward paper system? Are you willing to work with that as well or would rather start off with insurance companies that have an API? Are they willing to work with stripe if they do not have an API - this will allow you to build an automated system vs having to deal with paper bills?


Let me know if you'd like me to expand on any thoughts!

Good luck and my best,

Aleks

Thomas Kaled Business Development Consultant @ thomas.kaled@gmail.com

March 28th, 2018

You will need to determine this with each payer as you enroll as a provider.

Dan Hubbard Founder, www.FocusedAgility.Solutions/

March 28th, 2018

Talk to MTBC.

Adam Signaigo Available advisor :: Experienced operations, product, and services leader

March 28th, 2018

Thanks Aleksandra! I did basic research to see if there are plug/play services that can front end all/majority of payers. Sounds like healthcare is still driving one off, point to point connections. Appreciate the thoughtful response.

Paul Garcia marketing exec & business coach

March 29th, 2018

Wouldn't that be nice?! Unfortunately insurers do not want to make this easy. And since insurance is regulated at the state level, every single state is going to be different for the same parent insurance company. That doesn't even count the differences between payers. This is why entire businesses are built around insurance claims processing. But I assure you, the majority of it is manual labor, not automated at all. There's no incentive for payers to open their systems to third parties. Insurance verification is almost entirely a telephone-based function. And in the cases where it's an online function, ONLY the prescribing physician can access the insurance information. Permission cannot be given to a third-party, even by the patient. You have serious HIPAA regulations to follow being an insurance processor. And many insurers forbid the sharing of information with third parties at the get-go, so you can't even find out if the patient is covered.


It's incredible inefficient and will remain so until insurance is nationalized and standardized in the USA, and I don't predict that will happen in my lifetime.


In researching AmerisourceBergen, one of the three largest pharma distributors in the country, I had the opportunity to go through the insurance verification specialist training. It's mind-boggling how inefficient (mostly time-wasting) and complicated the insurance system is.



Satyendra Rai Software and Marketing Consultant

March 28th, 2018

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