Opkit

Automated health insurance verification platform

542 followers

Automated health insurance verification platform

542 followers

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Opkit (YC S21) is an automated health insurance verification platform. Our software helps healthcare providers efficiently collect, verify and track their patients' insurance.

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Launch tags:API•SaaS•Health

Launch Team

Viktor.comAn AI coworker that actually does the work

Promoted

Congrats on the launch! Well, I would say this is something different for once! Good to see something else than "ChatGPT for something" for once. What I am struggling with is the use case. I am based in Europe and I guess we are all health insured by default. Could this still be applied here?

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3yr ago

Opkit

Maker

@markus_sigel Hey Markus! Thank you for your support. Unfortunately Opkit is only available in the USA today - and in fact, due to the idiosyncratic nature of the US healthcare system, it would not have any application outside of the USA. There are a lot of benefits and drawbacks to the American system (which I won't relate here), but one of the big challenges we have is efficiently verifying patients' health insurance and determining their "coverage" (how much their insurance will pay) prior to their appointment. That's where Opkit comes in! We allow telehealth companies to verify patients' insurance and coverage faster, more accurately and more efficiently than before, which is a big benefit to both the patient and the healthcare provider.

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3yr ago

BlazeSQL

This looks great! I was in healthcare myself. You said your co-founder and you are both software engineers, but this sounds like something pretty specific that must have come from some inside knowledge about a genuine problem. Did either of you work in the industry? or how did you settle on this use case and figure out what to build.

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3yr ago

Opkit

Maker

@justus_mulli That's a great question Justus! Thank you. The idea for Opkit came from my personal experience as the son of an orthopedic surgeon. Growing up, I spent a lot of time around my dad's medical practice and I also got to see him go through the process of standing up an "ambulatory surgery center", a kind of outpatient medical facility. This is how I learned about the business of healthcare and how a medical practice operates. It's also how I became aware of how inefficient certain healthcare administration tasks are, including insurance verification! (My dad's practice has many front desk and call center staff who focus on insurance verification.) When Justin and I set out to start a company together, most of my ideas were related to streamlining healthcare administrative workflows... and here we are!

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3yr ago

I think it is great how streamlined you have made this process for providers and looks like an immediate value add to their daily practices and routines. Is there an upcoming feature/addition that you both are most excited about? I'm looking forward to seeing your success!

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3yr ago

Opkit

Maker

@nf285 I'm most excited about a feature we call "Collection Requests", which will allow providers to collect insurance card images from patients without any manual work or back-and-forth. When a provider creates a Collection Request, the patient will receive a text message or email asking them to upload their insurance card images using Opkit's card-upload experience (which will be linked). If they fail to do so after a certain amount of time, Opkit will automatically ping them again. Or, if they upload a bad insurance card, Opkit will automatically reach out to them for a different card!

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3yr ago

Congratulations on the launch! Too often, I've been misled into thinking a particular clinic or doctor was in-network, only to find out they hadn't removed my insurance provider from their website :/ Looking forward to Opkit making this a thing of the past! Do you have plans to support other lines of coverage besides health insurance in the future?

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3yr ago

Opkit

Maker

@w_h I'm really sorry to hear this has happened to you. Unfortunately, it's happened to many of us (myself included). Opkit is working to make surprise out-of-network bills a thing of the past. We have features planned that will allow providers to load-in their insurance contracts and automatically mark certain insurance cards as in- or out-of-network based on the networks they are associated with. Opkit works for medical, dental and vision today. We're focused on those to start. We hope to add support for pharmacy eligibility and benefits soon!

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3yr ago

Super exciting launch and must needed in the industry! What are the specific offerings on Opkit's automating features, both live and on the roadmap? Any thoughts on AI in the health tech space to work smarter?

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3yr ago

Opkit

Maker

@pskchang Pauline, these are really good questions. Opkit automates a lot of the insurance verification process, including certain parts of the process that fall outside of existing tools. For example, telehealth companies usually collect patients' health insurance information over the phone, email or a patient portal... This step isn't covered by Electronic Medical Record (EMR) systems or health insurance clearinghouses (which are used for the actual "eligibility check" piece). In contrast, Opkit has pair of features called Collection Pages and Collection Requests that can be used to collect insurance information from patients without any manual intervention whatsoever. We also have other automation features, such as insurance card OCR, recurring eligibility checks, and notifications for changes to patients' plans. These are just a few of the automation features that Opkit has! In response to your second question about AI in healthcare - this is a very hot topic right now. From what I can tell, most people are interested in using AI to improve diagnoses, automate Prior Authorizations (PAs), help doctors with treatment plans, or optimize medical billing. I think there is definitely potential for AI to be successful in all of these areas. I haven't seen anyone propose AI applications related to insurance eligibility yet, but Opkit is investigating this.

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3yr ago

Graphite

Congrats on the launch guys! Thinking back to when we built the provider-facing dashboard at Oscar, handling procedures that require pre-authorizations was one of the more challenging things to get right when showing eligibility details - how is Opkit thinking about handling pre-auths, both in the current product and in the future?

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3yr ago

Opkit

Maker

@merrill_lutsky Great question. Prior Authorizations (PAs) are a notoriously painful part of the US healthcare system. Opkit has explored adding PA automation features in the past, but we decided to focus on medical insurance eligibility for now. (The "do one thing well" principle.) Prior Authorizations (PAs) are a hot topic right now because the Center for Medicare and Medicaid Services (CMS) proposed some rule changes in December that would require insurance carriers to make the PA process "electronic". The rules wouldn't take effect until 2026, though, and insurance carriers may not comply right away. So I think PAs will continue to be a problem for at least the next 4-6 years. Opkit will likely add PA support in the meantime.

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3yr ago

Glad to see a solution for this that has such robust API support, and will certainly save a ton of time for practice admins and staff. Works great with Medplum as well - bonus!

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3yr ago

Wyndly

@reshmakhilnani Medplum + Optkit => 🚀 to the 🌔 !

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3yr ago

Opkit

Maker

@reshmakhilnani @kashshah_ The Master Plan!! Medplum is an incredible platform. FHIR is definitely the future, but unfortunately insurance eligibility is stuck on legacy APIs and standards. We would love for Opkit to be the bridge that allows FHIR-based healthcare providers to leverage eligibility checks!

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3yr ago

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