Show HN: Franklin – Out-of-Network Health Insurance Claims Filed Online

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.