Insurtech: Opkit Launches Insurance Verification Platform for Telehealth Firms, Virtual Medical Practices

Opkit has launched with an automated health insurance verification platform that is purpose-built for the new telehealth companies and virtual medical clinics that are “providing care for a wide range of patients across the United States.”

The startup, which “participated in Y Combinator, is emerging from stealth with initial funding of more than $1 million from Global Founders Capital, Mischief (Plaid founder Zach Perret’s fund), Socially Financed, Y Combinator and Rex Salisbury, former partner at Andreessen Horowitz.”

Collecting health insurance details and verifying coverage is “a complex, manual process that healthcare providers must perform before each appointment to ensure payment.”

Unlike brick-and-mortar providers, “which are regional and only deal with a handful of different insurance companies, telehealth companies serve patients from many regions and consequently deal with many different insurance companies and plans.”

This, along with the fact that telehealth companies are “unable to collect patients’ physical insurance cards and generally see more patients overall, makes accepting insurance particularly challenging for this new kind of provider.”

The telemedicine market “has recently reached 80% adoption, according to a just-reported study by Rock Health.”

The new report reveals “that telemedicine is the preferred channel for prescription and minor illnesses.” The global telehealth market is also “projected to grow at a rapid rate, reaching a CAGR of 24% from 2023 to 2030.”

This growth means administrative tasks “related to insurance, which are time-consuming and employee-intensive, have become a major problem for the healthcare industry.”

Sherwood Callaway, co-founder and CEO of Opkit, said:

“Telehealth companies are caught between a rock and a hard place when it comes to insurance. Patients want to use their health insurance to cover rising healthcare costs. They will forgo services that don’t have coverage. But for telehealth companies, accepting insurance is a huge operational burden.”

Callaway continued.

“Opkit’s platform makes the insurance verification process faster, more accurate and more efficient so practitioners can scale their operations and give patients better visibility into pricing and fees. Everyone wins.”

With Opkit, the health insurance verification process can be “performed in seconds and with just a few clicks, as opposed to taking an hour or more in a tedious process involving multiple apps, spreadsheets, and often phone calls.”

Opkit’s software “automates most of the steps involved in insurance verification, and automatically repeats this process for existing patients prior to each follow-up appointment.”

Opkit’s dashboard “allows telehealth employees to perform eligibility checks, or inquiries to insurance companies about specific patients’ plans.”

A range of eligibility-related features have been “automated for simplicity and speed, including determining whether a patient’s insurance plan is active, in- or out-of-network, and whether it includes benefits such as copays and deductibles.”

This information is used by staff “to determine if a patient’s insurance will cover some or all of the cost of services.”

Reshma Khilnani, a former Y Combinator visiting partner and three-time healthcare startup founder whose current company is integrated with Opkit, said:

“Opkit fills a critical need that has only become more important as telehealth has become universally accepted. Understanding the eligibility status of a patient as quickly as possible is key for telehealth companies to manage their day-to-day operations, collect payments and grow.”

Opkit’s modern, developer-friendly platform consists of two main components:

  • A web dashboard that allows users to load-in, verify and track patient insurance coverage manually
  • An easy-to-use, well-documented JSON REST API that can be used by engineering teams to perform insurance verification programmatically

Justin Ko, Opkit’s co-founder and CTO, said:

“Telehealth is an entirely new business model that stands to make healthcare more inclusive, accessible and affordable. But providers need updated tools that are built for a virtual care environment. That’s why we built Opkit–to reduce administrative burden for this next generation of healthcare providers.” 

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