File: PoP 281 Rachael Normans app Helps with Out of Network Benefits_Series 4 of 5
Duration: 0:28:02:09

[START]
Joe Sanok: We’ve created a lot of stuff. I mean opt-ins, PDFs, e-books. At Practice of the Practice, we are constantly developing things and making them accessible to you. But sometimes it’s hard to keep track of it all. So we just set up the landing page, www.practiceofthepractice.com/resources where we have put all of our free stuff. We have five free e-books there. The Practice of the Practice e-book, the HIPAA and security e-book that I wrote with Roy Huggins, the Adding Insurance to your Practice E-book, the How to Start a Group Practice E-book, the Alison and I created in the How to Start a Practice That Thrives E-book. Also we have got checklist there galore. We have got your website checklist, you Pinterest checklist, your 28-step checklist for starting a practice, and your group practice checklist. Also, we have got some guides there: “A Counselor’s Guide to Creating Websites,” “A comprehensive Guide to a Kick-Ass Content Strategy,” a guide to start a private practice, and tons more, info graphics, worksheets. We have over 20 different free resources there for you. So over at www.practiceofthepractice.com/resources, go grab them before we start charging.

[MUSIC]

This is the Practice of the Practice Podcast with Joe Sanok, session #281.

[MUSIC]

[INTRODUCTION]
Joe Sanok: This is the Practice of the Practice Podcast. I am Joe Sanok, your host, so glad you are here. We are all for helping people start, grow, and scale their private practices. We are hoping to save you time, so you don’t have to search around the internet for the best things. We just find them, interview those people and show you how to do it. So when I first moved back to Traverse City, I started my practice without taking insurance because all the panels were closed and I couldn’t get on. My intention was to get on them later, but then as my practice grew, my private pay, private practice grew, I realized, wow, there is lot of freedom here. And as I talked to people more, it seems like they really, if they are on insurance want to at least add some private pay or limit the insurances thereon or want to be out of network benefits for people. And one thing that we have done with our next level practice, that’s our supportive community for people they are just starting a practice, is we have helped them really analyzed. Do you want to take insurance. If you do, which insurance is do you want to be on. Who are you going to use as your biller. To really sort through that. And so if you want to be a part of that, that next cohort that’s starting, you can go over at www.practiceofthepractice.com/invite and we would love to have you be a part of that next cohort as that launches. Tends to sell out really quickly like in the first hour when the cohort launches. So one thing I have found is the way that you speak about out of network benefits is really important. Because if someone says do you take my insurance. And you just say. No, I don’t. Then that’s closing that door. So instead of saying no, you start with talking and educating people in regards to insurance and why we have decided to be an out of network provider. And so when we talk to someone on the phone in Mental Wellness Counseling, we explain to them that we are considered an out of network provider. What that means is you pay for services at the time of services. We then give you a receipt that you can submit for potential imbursement. Now, we have had clients that have received a 100% back, we have had other clients that have received nothing back, because they don’t have out of network benefits. And so when people select their insurance, they might want to look at that as part of it. Also you can always build your HSA, your flexible spending account as part of that. And lot of people have really high deductibles right now. And so you would end up paying for the counseling anyway, except do you want to pick the counselor or do you want your insurance company to pick the counselor. And so when we educate people around that, when we ask them about their deductible, ask them about HSA, ak them about flexible spending, we know they are more likely to come work with us because they focus on the expertise and the quality more than just does insurance taking.

[STARTING THE EPISODE]
So today our guest I am so excited to have Rachael Norman on. She has created an app that helps with out-of-network benefits and getting people the money back that they deserve from their insurance company. So without any further ado, I give you Rachael Norman.

[MUSIC]

Joe Sanok: Well, today on the Practice of the Practice Podcast we have Rachael Norman. She is the founder and CEO of Better. Better is an app that gets patient’s money back from their health insurance when they visit cash pay private practices – https://getbetter.co. Welcome to the Practice of the Practice Podcast, Rachael.

Rachael Norman: Thank you so much. It is wonderful to be here.

[SOME DETAILS ABOUT CASH PAY PRIVATE PRACTICES]
Joe Sanok: Yeah, I’m so glad that you’re here and so many of our listeners have private pay practices that are cash based. They’ve moved away from insurance. How do you get interested in this specific kind of area?

Rachael Norman: Yeah. So for me this is coming from two phases and the first is quite personal you know. Over the years, I’ve seen a lot of out-of-network health care providers that are cash pay, have a private practice, and I have had great insurance plans to work, and what I didn’t have was the time to deal with all of this and get money back from my insurance and even when I would file on my own, the facts would get lost or some typo would get made along the way, something would go wrong. And invariably, I wouldn’t actually get my money back despite having really great benefits. And I knew that if I was losing all of this money that a lot of other people must be too. So I wanted to build something to help and make this an easier process for people to give them a leg up in the system.

Joe Sanok: Yeah, and as you work with private pay clinicians, what are some themes that you see that they are interested in or that they are struggling with?

Rachael Norman: Yeah, so I think there are few different things that we see. One of the main ones is just what a time burden this can be for both the clinicians and their clients. Their clients, when anything goes wrong, are now in the middle doing a lot of administrative work with their insurance company, going back to their healthcare providers, being that person in the middle trying to figure it out. And often that means that even though the clinician doesn’t take insurance, doesn’t work with insurance companies, there is a strain in the patient-provider relationship where they are now being asked to fix things and figure stuff out when in a lot of cases it’s actually the insurance company that needs to do the work. So we see that as one of the bigger issues.

[ABOUT SUPERBILL’S]
Joe Sanok: Yeah, so there’s terms there, especially superbill, maybe for those that are newer, walk us through what is a superbill, what are some of the basics of that?

Rachael Norman: Yeah. So a superbill is typically the document, and it’s just one name for it. It can be called the coded invoice or other things. And this is a document that the healthcare provider can give to the patient after every session. Some healthcare providers do this a couple times a month or every month or every quarter. It depends on what works for them. And on this it will have all of the information that’s going to be required by the insurance company for processing such as information about the practice, name, address, the individual healthcare provider who actually saw the patient provided the care, information about them including tax ID and NPI as well as the ICD-10 diagnosis codes and the CPD codes that describe what care was provided and why to the insurance company.

Joe Sanok: So then for a typical superbill before your app came out, what was that process for the average clinician to provide that for somebody and then what was the process for a client to seek reimbursement?

Rachael Norman: So clinicians do this in all sorts of different ways. They can be handwritten, they can use the standard red, CMS-1500 template. Or they can use an EHR. That’s something like simple practice which is very popular with mental health practices and then that information would go to the patient and the patient would be responsible for submitting that to the insurance company. And in that work, the patient’s essentially being their own insurance biller. They are filling up paperwork, they faxing and mailing and if anything goes wrong either with the insurance company or there was some information or coding issue in the first place, it’s now up to the patient to sort through all of that figure out what’s going on and get it corrected if they are going to be properly be reimbursed.

[ABOUT DEVELOPING AND LAUNCHING AN APP AND ABOUT ‘BETTER’ APP IN PARTICULAR]
Joe Sanok: So what are kind of the steps that you guys took to examine whether this was something that people even wanted. I mean I imagine like when I hear, they are my guests. Of course, but I feel like everybody has great ideas. Like, take us back to being frustrated with not getting your money back to you. Then how do you become a woman who launches an app?

Rachael Norman: Yeah, well, for me there is the step of realizing that I have lost an awful lot of money not having the time myself to struggle through this process. And just not having the time to get to a fax machine somewhere and get faxes into my health insurance, do not having the time to sit on [00:09:32.23] for an hour just to be told what’s gone wrong now. So I was looking for a company that was doing this or someone that could help me. And there was nothing out there. I really couldn’t find anything. Besides you know, patient [00:09:47.15] gets an health care attorneys and they are far too expensive for small claims like I had. So that’s when I decided to get started on this and thought really let me know that if [00:09:59.26] company had a customer of one, because this was something that was such a big problem for me personally.

Joe Sanok: Yeah, if only you can overcome it for yourself.

Rachael Norman: [LAUGH].

Joe Sanok: So, for those who haven’t built an app which is probably most of us… I would like to just hear just the technical side of when you have an idea for an app, what are the steps after you have the idea to then start to build an app?

Rachael Norman: Yeah, so for me I was really lucky in that I’ve been working in tech. And so I had worked at a lot of startups before that built and ship software products and I also had a health background. I was pre-med as an undergraduate at Stanford, and I had done both in the US and abroad [00:10:43.20] health volunteer work. So I had a little bit of a leg up in both of these capacities, that I had worked in the system before. So one of the first things I did when I was really convinced that this problem needed to be solved was I went to software engineers I had worked with in other companies that I enjoyed working with and looked to find people that would be similarly passionate about this problem. And fortunately I was able to find quite a few folks and not something that’s really important to us in hiring who… they had had some type of personal struggle either themselves or their family with our healthcare system, and they are very passionate about supporting patients, supporting individuals and you know shifting that, the balance of power a little bit more in their favor.

Joe Sanok: So when you work with a software engineer, do you do it as a joint venture, do you just pay then an hourly? How does that work when you’re first building an app?

Rachael Norman: Yeah, so we’re structuring our company very much like any other traditional Silicon Valley startup. And so to start off, most of it is people joining the team for equity stakes or very low pay. And we are all hoping that the time and the sweat that we put into this project will pay off in the long run as we are able to help more and more people.

Joe Sanok: Okay. So then if someone else is building an app, if they want to build something, what would the next steps be after they connect with the software engineer?

Rachael Norman: So then it’s really designing your product. And one of things that we have done here that I strongly recommend is figuring out what the simplest incarnation of your product that works can be. So for us the very, very first version of Better, it only existed on my phone and it was [00:12:38.11] [CROSSTALK]…

Joe Sanok: Just for you to submit your own superbills [LAUGH]…

Rachael Norman: [LAUGH] I was the first one to ever submit a claim and it was un-designed, it was not very attractive, but it worked and it send claims in. So we had that and then we had done our work with the lawyers to make sure that the products as we designed it was compliant and it met all of the requirements of HIPAA and other State and Federal requirements. So those are the only basics that we had taken care of. And then I would actually meet with people in person and having them use the product and tell me how it made them feel and tell me what they wanted to be different and we’ve just grown from there.

Joe Sanok: So I am just picturing the listeners so that they can go beyond maybe just talking about your particular app, and thinking well what if I had an idea like this. Once they get that feedback, what’s the traditional launch look for an app after you get that feedback. People like it. It seems to be working well. Like how you then launch an app so that you can get some good traction?

Rachael Norman: Yeah, so that really depends so much on the app. There is some common things that startups often do. They will get hunted on Product Hunt which is a website that shares new apps and that’s one way. You can let the tech press or in our case of an health press, like Kaiser health news and others, let you know that you are out there and your app exists. And then for us one of the most valuable things is letting health care providers know that we are here. It’s a resource for them and their patients. There is never a one size fits all, but there are different things you can do depending on who your app is useful for and how you help.

Joe Sanok: So I imagine once you are ready to launch it, it just seems like there’s so many different, like insurance companies and plans and they vary by state. Like my mind is just spinning, thinking about all of the ways that you have to integrate this one app into a million different insurance plans. How does that work?

Rachael Norman: Well, so it is complicated and there are roughly at 9000 pairs in he United States and there are lot of difference between them, but fortunately there are also lot of similarities. The Affordable Care Act and other recent legislation, it does require that for the most part between plans there are going to be a lot of commonalities and things that plans are required to cover or ways that you can expect them to respond to a claim. So those things really help us on knowing what to expect and knowing something is in outlier. And we think that we should be able to get that person a better outcome on their claim, whether it’s the amount that the insurance company is allowing and paying being oddly lower than we would expect or whether it’s a strange denial that we wouldn’t usually see that we think as an insurance company error. So all of those type of things we’re able to dig in research when stuff is unusual because there are enough commonalities that it’s pretty easy to spot.

[INSURANCE REQUIREMENTS – CODING CHANGES ETC.]
Joe Sanok: Yeah, I have noticed recently that a number of my consulting clients in their states have been required to register as an out-of-network provider with plans. Is that something you are seeing in other kind of plans across the nation?

Rachael Norman: Oh, yes, yes. This is a trend that we have seen grow recently over the past few years, and it’s something that we’re expect to continue. It can be tricky to get through mostly in getting in contact with the insurance company getting the correct forms, understanding exactly what information they are requiring and that something that we help healthcare providers out with for free. So if you are seeing that, then you need more information from the insurance. You’re welcome to reach out to us and we can give you the forms and some guidance on how to get through it efficiently.

Joe Sanok: Yeah because even just a few years ago if you just said I’m not on the insurance panel, people could still usually send in, you know, a superbill and that company wouldn’t necessarily know me as a provider, but if they had my EIN and they had kind of the NPI and all the diagnosis codes, those people would get reimbursed, but now it seems like more and more insurance companies are saying, no you’ll have to register with us to be out of network which just seems so… like the reason many people aren’t on insurance panels is because they don’t want to deal with all of the things that insurance companies are asking for.

Rachael Norman: Yeah, exactly. And well from the insurance companies perspective, when they explain why they are making these changes, they will say it’s to sort of modernize their computer systems, make sure they have accurate data on health care providers and to combat fraud. But we are also seeing a lot of claims going unpaid forever because these processes aren’t well communicated and aren’t well explained, and so very few individuals who have that health insurance or the out of network healthcare providers are aware of these changes and that means the person just never gets their money back. So it’s something that it’s really important to us to explain and clarify and help people through the process, so that these claims still can get processed.

Joe Sanok: So how do you guys keep up with all the coding changes and ICD-9 or ICD-10 or CPT… how do you as a company keep up with all those changes?

Rachael Norman: So it’s a lot to keep up with. But fortunately it’s something that software is very, very good at. So that’s a great job for the computer, is to check codes to find out is it valid on this date on [00:18:30.08] does it work with other codes on the statement or is there a conflict. So we leverage software there and then share that information back with healthcare providers. Right? It can be very, very tricky to keep up with the coding changes, especially as they are just increasing in specificity and in many cases simply adding a digit… you know, it’s a lot of moving parts in it, so lot of details. So wherever possible, we will reach out individually to health care providers, let them know of coding changes and the new options, when we see it causing an issue with the specific superbill or to more globally to help people keep up or publish blog posts where we are kind of condensing the highlights of not only what is changing, but how it’s changing, to help people keep up and kind of better understand what those changes look like.

[GETTING CLAIMS SUBMITTED THROUGH ‘GET BETTER’]
Joe Sanok: So walk me through a counselor that owns a small practice and one of my clients says, hey I heard about this thing called Better. This is going to help me get my money back, what as a clinician, as a practice owner would be my experience? Maybe walk me through what it takes on my side. Then maybe we can walk through what the client experience is in regards to getting the claims submitted. So first as a counselor what would I experience?

Rachael Norman: You know, from a counselors perspective, there’s really no change to your practice. We have brochures and different things. We can put that on your website. So we are able to let your patient’s know. But you do not have to sign up or do any other work. And you can continue to create your Superbills exactly the same ways you always have, whatever works for you. We try to keep it really simple and only a value add from that perspective. For your patient, they are going to sign up either by downloading a app or going to our website and signing up online on their computer. Sign up will take them a minute or two. They are answering some basic questions – name, date of birth, address. They are authorizing Better to be their patient advocate, so that we can talk to their healthcare providers and their insurance. It’s a very important step. And then anytime they get a superbill, they can simply take a photo or if it’s being sent to them electronically – some EHRs do that, they can forward that email on to us, which only takes one or two seconds and then we have the claim. We do the rest of the work. They just sit back and wait for their money back from their insurance.

Joe Sanok: So when someone gets a receipt in our office, for example we have a spot for diagnosis codes, CPT code. they would need that on that to submit it and they probably would need our EIN, I imagine?

Rachael Norman: Yes. Tax id very important and also NPI if it’s available. That can help them go more smoothly, but the most important is a CPT code, the ICD-10 diagnosis code, and the tax Id for that practice.

Joe Sanok: And once that’s in their app, do you have to have that for every single bill or is it like once Mental Wellness Counseling is in there, we have that EIN and the NPI already stored.

Rachael Norman: So we strongly recommend putting it on every superbill. You know we do keep information about practices and as things change we can [00:21:48.19] that globally and make it really simple for everybody, but we never know, right? Is this still going to be mailed? Is it going to be faxed on directly? You know so many things can happen. So we strongly recommend that anytime you’re giving a patient a Superbill, did they have all of the information required by insurance?

Joe Sanok: So then for the client, they submit it you, what then happens kind of behind the app? What you guys do? What can the client expect? How will be their experience after they submit it?

Rachael Norman: Yeah, so the first thing that we do is we review the superbill to make sure that all of the information is there and correct. We check the codes and that’s a combination of both humans and software. There are something software is much better at and there are something where a human has to… just say, for some doctor’s handwriting, make sure they were getting it right. Once everything has been reviewed, it’s then transmitted to the insurance company and then we continue to follow up and make sure that the claim is going to the system correctly. So if the claim gets stuck because there is an involvement issue or more information is needed from the provider or there is a typo mistake on the insurance site that causes an incorrect denial, we help with all of those things. We fix anything we can at the insurance company and make sure that claim is getting properly reimbursed. Once there is an outcome, we check the outcome. We make sure that it looks like it was placed correctly, that we don’t see any [00:23:20.01] in how it’s paid back, not too much is going towards the deductible. So we would be in know we are getting the right amount of money back to that person.

Joe Sanok: So what are the costs for someone that owns a practice and what do they cost for a client that’s coming. I imagine you have to get paid to do all this work for somebody [LAUGH]?

Rachael Norman: Oh, we do it. It’s a lot of work. So for practice, it’s absolutely free, and I think that we support with, be that questions about coding, guiding through the enrollment process, following up with insurance. All of those things that we offer, absolutely free. For the individual filing a claim, so for the patient, we charge 10% of the money that they are getting back from their insurance. So if a claim is applied to their deductible where it cannot be covered under their policy, our service is absolutely free. We’re only charging when we are getting focused results.

Joe Sanok: Wow. Okay. So they are saving themselves a whole bunch of time and hassle, and then they get 90% back of whatever is coming back to them.

Rachael Norman: Exactly, [00:24:25.11] [CROSSTALK]…

Joe Sanok: Which is way more than what most people are not getting back anyway. They usually end up like leaving the receipt on a desk and then don’t ask for that money back anyway.

Rachael Norman: That is very true or with the volume of mistakes that we find, we more than [00:24:39.04] just correcting those error and making sure that correct amount is going back.
 

[CONCLUSION]
Joe Sanok: Wow. Well, I imagine as you guys do this more, you’ll probably find more opportunity to kind of increase that process and productivity and [00:24:51.27] in customer experience. Well, the last question I always ask people, Rachael, is if every practice owner in the world were listening right now, what would you want them to know?

Rachael Norman: I think the thing that I would want to know is [00:25:06.06] the basics, the most important things to put on superbill is to have that tax ID, that NPI, and if there is a group practice and individual [00:25:17.28] hospital, we want the NPI for both the practice and for the individual provider that helps so much with a lot of insurance companies, and then the CPT codes and ICD-10 codes. I think that would be the thing I would like everyone to know.

Joe Sanok: I love it. I could just tell that you are an analytical tech person because that’s super practical. Rachael, thank you so much for being on the Practice of the Practice Podcast. If people want to connect with you or get this app for their clients, what’s the best way for them to connect?

Rachael Norman: Yeah, so any questions, go ahead and get in touch at [email protected]. You can also go to our website, https://getbetter.co and you can request brochures, check our blog that has lots of information on enrolment and coding changes and individual stories of people that really had challenged the system. We are always here to help. So please reach out anytime.

Joe Sanok: Awesome. Well, thank you so much Rachael, and have a wonderful day.

Rachael Norman: Thank you.

[MUSIC]

Joe Sanok: Well, thanks so much for listening today. This was our fourth fierce female in February and it has been awesome having all these amazing women on the podcast this month. Next, we are going to have Andrea Maxim. She is a doctor, a naturopath, and has grown a cash pay practice and is going to share all the insights of that. So really excited about that. Then we have a bonus person, I’m going to actually reveal in the next podcast. So it’s going to be our sixth fierce female in March. So doesn’t quite roll off the tongue saying it’s five fierce females. But thanks for letting us into your ears and into your brain. Please let people know about this podcast. We are so close to hitting a 100,000 downloads last month and we would love to having spread the word. If you find this valuable, rate and review us on iTunes. It’s a great way to show new people that this is a podcast worth following and we are helping you start, grow, and scale your practice. Have a great week.

[MUSIC]

Special thanks to the band Silence is Sexy for the intra music and this podcast is designed to provide accurate and authoritative information in regard to the subject matter covered. It’s given with the understanding that neither the host, the guest, or the publisher is rendering any legal, accounting, clinical or other professional information. If you need a professional, you should find one.

[MUSIC]

[END OF PODCAST 00:28:00.23]