An audacious little Oakland-based start-up called Better is tackling one of the most critical problems in America’s nutty healthcare system: people getting buried under heavy "out-of-network" healthcare expenses.

That’s an important but underpublicized issue for people with diabetes (PWDs), who spend on average 2.5 times more for “out-of-pocket” healthcare costs than those without this condition.

Better is tackling this problem head-on, dealing directly with the much-dreaded insurance companies to help individuals recoup their money whenever possible -- with quite a surprising success rate. And how they are doing it is just as noteworthy as the fact that they’re able to do it at all.

Using their mobile app, you just snap a photo of your out-of-network bill and send it to the company. Better then handles the entire claims process for you. Their staffers who are insurance policy wonks analyze billing codes and contracts, using their proprietary software. If you get reimbursed, they take a small cut; if the claim is unsuccessful, you pay nothing.

Yes, it really is that simple. 

In the couple short years Better has existed, they've helped people file more than $2 million in out-of-network claims and get money back. And if that wasn’t noble enough, this young startup’s also working to wipe out $16 million in medical debt across America so people are completely free from that health-related financial burden.

Better is ushering medical billing technology into the 21st century. So it’s no wonder that Better’s co-founder and CEO, Rachael Norman, got rapt attention at DiabetesMine’s Innovation Summit in November 2017, when she explained how consumers get short-changed on healthcare bills and how Better helps them. 

“Our goal is to help every American tired of fighting against the system who wants an easier way to use their insurance and see the healthcare providers of their choice,” Norman said. “It all boils down to letting people know they’re no longer stuck with the problem, they no longer need to be on their own.”


From Med Student to Billing Crusader

Interestingly, Norman didn’t start out with the idea of helping people navigate healthcare bills and medical debt. She actually went to Stanford University with plans to become a doctor.

But after meeting numerous physicians who regretted their career paths and “complained about how broken the system was,” Norman changed her mind.

After graduating in 2007 and going to work in operations and sales for several small tech manufacturers, she began experiencing her own problems with out-of-network health insurance claims. Similar medical bill woes surfaced for one of her friends after a burn injury, too. 

That turned her attention to the health insurance business, and Norman teamed with a former Facebook engineer, John Stockdale, to tackle the problem. They came up with Better, incorporating it in March 2016. 

Their idea was simple -- using a mobile app to bring a Pinterest/Instagram photo-sharing flavor to the overly-complicated, stuffy and time-consuming medical billing process. It’s almost deceptively easy, a far cry from how the system has traditionally functioned.


A Very Broken System

For those lucky enough to have health insurance, you probably know the drill on how the out-of-network medical billing process currently works. These are the charges you pay to providers, pharmacies, and supply companies that aren’t a part of your insurer’s network:

  • First, you pay out-of-network providers up front (unlike in-network providers, who are paid by the insurance company and usually leave you with only a co-pay to pay).
  • Then you get a bill from your provider with mysterious codes and other mumbo-jumbo.
  • You’re supposed to file a claim with your insurer to get at least some of your money back. But, “it’s such a complicated process, most people don’t get through it,” Norman says.

Embedded into those above three steps are medical billing mistakes and other issues, making the process even more difficult to navigate. These errors are shockingly common -- wrong billing codes, doctor’s offices providing incomplete info, data-entry typos where a patient’s name or birthday is incorrect. One study found mistakes in 49% of Medicare claims, and others indicate the error rate by private insurers is even higher. Sometimes it's not even clear what's covered, because health insurers use intentionally ambiguous language in their lengthy, legalese-saturated contracts. And often those documents aren’t easily accessible to those who need to find them to review.

This is not even taking into account lost paperwork or finger-pointing over why the correct documentation isn't where it should be, and how many patients just don’t have the time, patience or understanding of insurance lingo to argue with medical billing decision-makers. Too many people just throw up their hands and give up any efforts to get their money back. 

And that’s where Better comes into play. 


A Better Way: Shaking Up Medical Billing

These days, taking a picture with your smartphone and sending it off is a quick and easy task. With Better, you just upload your health insurance card into the app to get started, and then for each claim, just snap a photo of the bill and push a few touchscreen icons. And then you're done! The Better staff is on the case; they start calling insurers and providers, and working through all the necessary paperwork and appeals in order to get your money reimbursed.

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Right now, the app is available for iOS devices in the iTunes store and an Android app is in development.

They started off with just a couple people doing the legwork, before hiring more employees to streamline the process. As of last summer, Better had seven full-time staffers and continues to grow, Norman says. They currently work with multiple insurance companies, starting out in California and expanding their services into other states.

As Your Insurance May Vary, it can be anywhere from days to months for a given health insurer to reimburse a particular claim. According to the company’s website, Better users to date have received an average $1,233 per year in reimbursements (though again, that amount may vary case-by-case).

Better also emphasizes that it uses secure, encrypted servers and channels in processing this sensitive health and personal data, to comply with HIPAA privacy rules and FTC regulations.

In exchange for these services, Better takes 10% of the money you get paid back. Unlike other companies or orgs that only deal with insurers once a claim is denied, Better distinguishes itself by getting involved in the process before the claims are filed.

“Even if it takes wading through stacks of documents and making lots of phone calls, we do it, so you won’t have to,” Norman says.

Bravo!!! That’s a great idea, not only because it helps people keep money in their pockets; it also relieves them of considerable stress. I can’t think of more soul-draining encounters with bureaucracies than the ones I’ve experienced when dealing with health insurance companies.


Helping Vulnerable PWDs

It’s easy to understand why Better says it’s seen significant growth in claims from the diabetes community. For one thing, PWDs are more likely to turn to out-of-network specialists for a range of healthcare needs – from routine endocrinologist appointments, to eye exams, kidney dialysis, and mental health counseling.

Norman says the service Better provides helps PWDs stick with that specialist of choice, and helps recover money they’re owed from insurance so they can avoid the hassle of changing doctors and disrupting continuity of care.

What’s more, Bettercan help PWDs get money back after they purchase insulin, diabetes supplies and medical devices from out-of-network pharmacies or from manufacturers (!)

While that’s not a big chunk of their business, Norman notes anything that helps PWDs cope with the deplorably high cost of insulin and other medical necessities deserves praise. 

“For a lot of people, it becomes magic that we’re able to solve those problems and get them the money they are owed from insurance,” she says.

Take the story of Campbell Charshee, a type 1 PWD in New Jersey who in a Huffington Post piece last year described a litany of health insurance woes. He wanted to stick with his out-of-network endocrinologist when he got a new insurance plan in 2015, but had trouble getting reimbursed for his visits to the endo and some lab work.

“I quickly got tangled in red tape,” Charshee said in that article. “Both the hospital’s billing department and my insurer either passed the buck on my questions, or blamed me for not paying bills about which I had legitimate questions.”

Unfortunately, Better wasn’t around that year to help him. But Charshee knows how powerful this service could be and in a recent blog post, he praised the startup company.


Expanding Service, Forgiving Debt

While not disclosing precisely how the company plans to scale up its operations, Norman says “we have a clear road map for building a nationwide business.”

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Norman also wants do more in the advocacy arena, and Better is already boldly stepping into that role.

In fact, Better has already been working on the noble goal of forgiving $16 million in medical debt for 10,000 people across America. This is huge, given medical debt is the leading cause of U.S. bankruptcies. Better has partnered with New York-based non-profit RIP Medical Debt to purchase medical debt for pennies on the dollar, wiping away that outstanding balance completely so people can be free from their health-related debt. They’re 43% toward that total and Norman says the hope is to surpass the $15 million in medical debt that late night comedy host John Oliver forgave in his well-publicized campaign a couple years ago.

Beyond the debt forgiving, Norman says she hopes her company can “shine a light on how insurers are not living up to their promise,” perhaps helping healthcare advocacy organizations and insurance companies create “lasting change” toward more efficient medical billing and more affordable healthcare. 

Amen to that. We certainly need it, with the way the broken healthcare and insurance coverage system works now. The diabetes community (and beyond) should wish her luck!