The medical billing industry is a complex and difficult to understand process that many find confusing. The byzantine nature of the medical billing industry frequently leads to many individuals seeking health care being surprised by astronomical medical costs.
Compared to the rest of the world, the US health care system is one of the most overpriced systems. There aren’t many other nations on the planet that have the habit of charging upwards of $300 for the use of hospital bedsheets, or $9000 for a pair of scissors.
According to statistics released by the center for disease control, the cost of health care in the United States has doubled over the last decades, which is, in part, due to the unregulated nature of medical costing. The medical billing industry taps into to a massive $55 billion dollar market, which, if previous trends are anything to judge by, is set to double again by 2027.
Part of the reason medical billing rakes in so much money is due to a lack of awareness on the behalf of the patients. Concerned with profit margins over the financial impact on their patients, doctors will often recommend higher priced treatments in favor of low-cost alternatives that are just as effective.
Combined with the estimated 14% of the total revenue generated by medical billing caused by unnecessary and unproductive administrative practices, the medical billing environment is murky, intentionally obfuscated, and extremely difficult to anticipate costs within.
A new startup, however, is seeking to shed some light on the cost of medical treatment in advance. Eligible is a new service that is set to help patients anticipate exactly what they’re paying for and how much it costs before setting foot in the doctor’s office, with the aim of completely reforming the medical billing industry.
In this article, we’ll find out exactly what Eligible does and how it works, as well as providing some insight into the journey of the service from startup to a fully-fledged integrated approach.
The Eligible Medical Billing Story
Eligible is the brainchild of Katelyn Gleason, an entrepreneur based out of New York that, before seeking to revolutionize the medical billing industry, was working as a sales rep and waiting tables to put herself through college.
Soon after finishing college, Gleason found herself working endless hours as a sales rep for DrChrono, one of the largest patient care platforms in the United States, dealing with practice management and medical billing systems.
During her time at DrChrono, Gleason identified a real need in the industry for medical billing reform. Seeking to create a new, more efficient platform, Gleason set out to create a medical billing platform that incorporated cloud data sharing techniques to shake up and optimize the industry.
The primary issue in the medical billing industry is that when a patient visits a doctor, they are at the mercy of the recommendations of the doctor when selecting a treatment. Most patients aren't comfortable questioning the advice offered by medical professionals, and are prepared to take recommendations at face value.
When a doctor recommends a treatment for a patient, there's quick, conclusive, and reliable method of determining whether the health insurance covers the treatment in question. Similarly, there is no reliable way of determining what the final cost of treatment will be, or whether there are any other more cost-effective treatments that deliver the same results.
This system leaves patients poorly informed, as well as making it difficult for medical practitioners to ensure that they are managing remittance efficiently, which results in unpaid medical bills and patients suffering from extremely large medical debts.
Gleason’s system presents an elegant solution to the problem of inaccurate medical billing practices, streamlining medical billing processes and providing a clear picture of the total cost of treatment in addition to alternative information to make the process easier for both doctors and patients.
What is Eligible Medical Billing?
Eligible is an integrated patient healthcare availability platform that is able to communicate with platforms such as Cleveland Clinic, Quest Labs, and One Medical to deliver conclusive information on how much a treatment will cost, what the total co-pay value amounts to, and provides detailed information on the entire payment process.
Eligible is even able to present payment options to patients that remove the months of waiting that occur between treatment and the final billing process. According to statistics released by Eligible, clinics and doctors that use the service collect 50% more remittance than those that don’t, as they are able to process upfront payment from patients instead of embarking upon a long and costly process of remittance recovery after treatment occurs.
There are a number of other startups that deliver similar services to Eligible, such as iVinci, but these startups mostly use a custom-built API that Eligible licenses to them. The service itself is extremely feature-rich, offering features such as their recently released AI.
The AI system, called Ellie, is an intelligent algorithm that patients are able to actively converse with in order to learn more about the billing process, gain detailed insights into the cost of their treatment, and find out about alternative treatments.
The case studies offered by Eligible on the efficacy of their solution are certainly compelling. The company has released figures from organizations such as Zwanger-Peseri, who have seen a 300% increase in revenue growth since engaging Eligible, and Radnet, who experienced a $7,000,000 growth in revenue after integrating the Eligible solution.
The Eligible platform offers a broad spectrum of functionality. Incorporating advanced machine learning processes and automation practices, Eligible deliver data-driven payer lists, real-time interfaces that provide extremely accurate and up-to-date information on the health insurance benefit of a patient, same-day integrations, connectivity management, and advanced workflow capabilities.
The Future of Eligible Medical Billing
According to Gleason, the company has been running at profit for several years now, and is now focused on increasing profitability and market penetration. With solutions scaling from startup level to Fortune 500 level capability, Eligible has been slowly transforming the medical billing industry, and is set to develop a wide range of advancements in the health tech world.
