Startup Spotlight: Eligible

Demystifying the US healthcare system could save patients thousands


The US medical system is, at times, difficult, to get your head around. In the largely private industry, there is an obvious necessity for insurance, and going without it can be both dangerous and costly. The fact that uninsured mother of two Wanda Wickizer could be handed a bill for nearly $500,000 after treatment for a subarachnoid haemorrhage - which would have been fatal without emergency action - stands as an example of just how destructive the system can be. Medical bills are the biggest cause of US bankruptcies, with some 643,000 people filing every year. Only in America can medical treatment ruin a family, the process of recovery all too often compounded by financial insecurity.

The Week magazine described the US healthcare system as a ‘Kafkaesque labyrinth of private and public bureaucracy,’ and its something most of its dependents won’t properly know the extent of until they’re involved in it. This bureaucracy and confusion is nowhere more prominent than it is in medical billing. As noted by the New York Times, what many might not understand is that ‘the current medical-billing system itself is responsible for the high prices patients are charged.’

The system of coding and billing is so complex that it demands an entire industry of consultants and back-room experts ‘whom medical providers and insurance companies deploy against each other in an endless war over which medical procedures were undertaken and how much to pay for them.’ 25% of the US’ hospital spending (more than any other area) goes on administrative costs, with billing a large part of that admin.

Because of this, bills are inflated, and the medical billing industry will pull in some $55 billion globally by 2020, according to TechCrunch. Onto this backdrop, Katelyn Gleason - founder of electronic health records company DrChrono - founded Eligible, a medical billing startup designed to demystify the process and ensure patients know how much they are expecting to be charged before they set foot in a doctor’s office. There is currently no way for patients to know what the final bill will look like, or whether there is a cheaper option covered by the same insurance plan. Gleason told TechCrunch that ‘routinely collect 50% more revenue per month using Eligible, since they’re not stuck trying to collect bills after patients leave the office.’ The company boasts ‘agnostic and robust’ integrations with the express purpose of increasing transparency (for customers and doctors alike) and decreasing denied claims.

The company is also offering a set of versatile APIs in an effort to bring the healthcare industry into the 21st century. Eligible’s work is particularly interesting given the current political situation in the US. The Trump administration is attempting to dismantle Obamacare, and though that was no panacea in itself, the replacement is incredibly unlikely to be any more accessible. In instances like this - and, crucially, in areas like climate change - the US will be relying on innovation to offset potentially damaging reforms. According to Gleason, Eligible’s 14 million transactions per month is expected to grow to 50 million by the end of 2017. With other smaller companies getting on board to use its software, Gleason will be hoping that Eligible can bring about much needed change in a healthcare system in desperate need of reform. 

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