
Show HN: Franklin – Out-of-Network Health Insurance Claims Filed Online - dhruvmanchala
https://www.getfranklin.co
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dhruvmanchala
Hi everyone, here's more info on our project. Would love any feedback!

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In 2019, my cofounder Hiroki and I started Neb, a startup to find people
therapists. We would call and email therapists, and screen them, to recommend
the best therapists to our users. After finding therapists for 3 months, we
came to the conclusion that it was simply impossible to consistently find in-
network or affordable therapists. We often had to reach out to 50+ therapists
per user to find an available, affordable match, and for in-network therapists
in particular, emails or any other form of online contact weren't available,
which meant we had to call 50+ therapists. And sometimes there wouldn't be a
good match - no available therapists in the area who were in-network or within
the user's budget.

We could only consistently find therapists if users could pay $150 or more per
session. We were quite demotivated by this discovery. We didn't want to make a
luxury product. We wanted to make healthcare more accessible and this went
against our values. Our experience did show us there was an opportunity to
help Americans afford care, so we pivoted to filing out-of-network claims.

(Better was a startup doing the same thing that unfortunately had to shut down
last year because their founder passed away. We know about them and have high
regard for them.)

If you have a PPO or high-deductible health plan, which close to 80% of
Americans with private insurance have, after you hit your out-of-network
deductible, even if you see an out-of-network provider, you can usually get
reimbursed for a portion of your expenses. Even with rising deductibles, this
means some people can save a significant amount on healthcare. Related but
increasingly significant, insurance covers a growing number of over-the-
counter medical purchases, from supplements to nicotine gum to eyeglasses, but
users have to file claims themselves.

Mental health is the sector for which this is most relevant. First, mental
healthcare involves recurring visits - a full course of psychotherapy often
involves 15 or more sessions. Second, for various reasons a lot of mental
healthcare providers don't take insurance. About 45% of psychiatrists in the
US won't see new patients with insurance.

We don't have hard data on this yet, but from our experience we suspect a
significant and growing number of other healthcare providers - therapists,
chiropractors, physical therapists - are out-of-network. And 11% of doctors
across all specialties don't take any insurance. According to some sources,
$60 billion in out-of-network claims are processed annually, and the amount
that could be reimbursed but isn't, because people don't file claims, is
possibly much higher.

Unfortunately, out-of-network insurance is both not well-understood and
frustrating to use. Many people don't know what out-of-network insurance is at
all, and simply pay for services in cash. The filing process is utterly
archaic. Your healthcare provider has to give you what's known as a superbill,
an itemized bill with diagnosis and treatment codes needed by insurance to
reimburse. You submit this superbill along with a completed form to your
insurance, most commonly by mail. Claims can take over a month to be
processed, and funds aren't deposited into your bank account - you get a
check.

A significant number of claims are denied because the superbill was incomplete
or inaccurate, or because of some unknown confusion on the insurance side. To
resolve claims, you have to call your insurance. Claims customer support staff
are trained to deal with only very specific common issues unrelated to your
claims, and are often offshore. Two different representatives may tell you two
different things. As a result of all these factors, people are not reimbursed
enough for their out-of-network and other out-of-pocket expenses and are
spending a lot more on healthcare than they should be.

At Franklin, we're building a service that files out-of-network claims for
people. Simply send us a photo of your superbill, and we file your claim for
you. If a claim is denied, we talk to your insurance to understand the
problem, and then reach out to your healthcare providers to get the
information needed to resolve the issue. You simply receive the check mail in
the mail. (We want to have direct deposit at some point in the future.)

It is insane that so much money is being left on the table and people are
paying these massive healthcare bills entirely out-of-pocket. With Franklin,
we intend to help make mental healthcare and other healthcare more affordable.

