Caspio Powered Healthcare App For Insurance Approvals

Speaker A: Foreign

Speaker B: welcome to Caspio's Low Code High Impact podcast. I'm your host Paul Quirk and on this show we uncover how businesses are using low code to drive real results. Each episode brings you insights, practical tips and success stories that showcase the power of low code. Today I'm joined by Samantha Bridge, the founder and CEO at Peel Tech Allies and Cameron Floyd, co founder at Zertane, one of Caspio's gold partners. Welcome both of you to the Caspio podcast. So let's do some quick introductions. Samantha, can I please ask to introduce yourself?

Speaker A: Hi, yeah, I am CEO and founder of Appeal Tech Allies. Um, I am a nurse, um, by training and have been a nurse for almost two decades and have a great passion for helping others and making things easier for people and developed the company Appeal Tech Allies, uh, last year with you know, not just helping one person at a time, but really the concept of helping multiple people at a time, um, through technology.

Speaker C: Great.

Speaker B: Um, Cameron, can you please introduce yourself?

Speaker C: Yeah, sure. My name is Cameron Floyd, co founder and managing partner of Zertane. We are a, ah, pure play hyper automation company. We help companies um, accelerate through the ideation of their great ideas and we translate those through our uh, unique um, uh, information gathering and requirement gathering techniques and we utilize low code platforms to accelerate outcomes and we love using Caspio to do that.

Speaker B: Great stuff. So let's go into some um, questions that we were talking about earlier. So Samantha, from your side you've already mentioned you've got two decades in the healthcare industry, uh, what motivated you, um, to start Appeal Tech?

Speaker A: So working with um, consumers that experience denials in their health insurance, um, is a huge pain point and a lot of misunderstandings and having been in that space for over a decade, um, wanting to see something done about it and there really being a lack of consumer products in this space overall. And you know, uh, most products in this space are developed for businesses, um, for the healthcare systems but not a lot of information out there to help consumers. And so I've been waiting and waiting and waiting for somebody to come and fill this void and nothing happens. So I made the leap last year. I'm like, I'm going to do it, I'm going to do it. It's, you know, the need is still there and um, you know, there's a lot of confusion when somebody does get a denial in their health insurance about the whys, can I appeal it or will it just be denied again? Um, so a lot of passion there with ah, that um, kind of what

Speaker B: you're building on what you're saying there is what really empowered you to think about building something directly for the partners versus going business to business.

Speaker A: So uh, in this space, like even with um, consumers get stuck in the middle, patients get stuck in the middle. The patients will go to their providers and the providers will say, the insurance company this. And then the insurance companies will say no, your provider this. And there's this real need in this space, um, to help the consumers, even with providers, um, as well, I've had some providers approach me as well, saying, hey, could you help us? Could you do something for us? So more to come on that in a future episode.

Speaker B: Yeah, I think it's a great idea. Um, Cameron, um, Zertane's been a partner of Caspio, um, since September 2022. Obviously I'm a gold partner now. So as a co founder, um, what was the driving factor for you to create Zertane?

Speaker C: We saw in the market, um, an opportunity where there were enterprise players, big four consulting firms that were um, gathering requirements, refining them and really taking people from requirements to release. However, there was a large investment required. Um, it took a long time. And so when Pavana and I sat down and looked at the gap in the market, it was really looking at that uh, enterprise SMB client, uh, the person who has similar requirements to maybe enterprise organizations, uh, you know, HIPAA compliance or you know, high processing, um, or PII data. And so we really wanted to fill that gap. We wanted to lean in, uh, and figure out a way where we can build platforms, uh, and provide services to cut the time to product utilization and realization in half. And Caspio fulfilled that need. Uh, it's been fantastic to be able to build uh, applications, launch um, and test those applications and iterate um, in an accelerated way, um, and allow our clients to sort of experience that as we go along rather than a big long development cycle, a big long, um, requirement gathering session and getting something in months and months and months and months. We're able to actually bring forward the engagement with the client, um, to iterate on different variations and then release something that's mature and we can then build upon that if we did an MVP and then add additional features in a very easy way. So that's why we, we love Caspian.

Speaker B: So Cameron, from Zertane's perspective, is there any particular organizations or industries that you specialize in?

Speaker C: Uh, we've actually been doing a lot in the allied health sector. So aged care, disability services and healthcare, um, insurance, funnily enough, um, and financial services as well. It's Been a fairly broad spectrum m a lot of commercial markets as well. So, um, I think Caspio solves challenges across many different industry sectors. Um, and it's really everything that I mentioned a little bit earlier about, um, finding it hard to develop and cut code or build on existing heavy, uh, code sets. Um, we're able to turn around applications that are engaging, that look great, um, and actually are functional certainly around business process, um, and compliance and security and governance. So yeah, it really does a great job in industries that have those requirements, uh, and parameters.

Speaker B: Great. And from your side, Samantha, how did you find Zerten? Was there a point where you thought, actually, I'm gonna need some developers to help me build this application.

Speaker A: So, um, last year when we were, ah, when I came up with the idea, so to transition from just a, like doing a consultant work, you know, one by one to a let's build an application. Like, let's make technology, you know, work for a lot of people, help a lot of people. You know, the more people we can help the. And started, um, looking into, okay, who do I know in the it. In the IT sector, right, Because I've been healthcare and so my experience in, you know, I didn't go to school for coding, um, or our technology. And that essence, I've dabbled a little bit. And so I felt confident of going down this pathway, um, and got some consultants. And one of them goes, oh, I think I know somebody. And it was Pavan, um, who owns Zertane and uh, made the introduction. And from meeting Zertane, from the beginning, it was, I want to say, like white glove service. Uh, we explained what we wanted to do, um, coming with somebody with not that background. Right. So all of the things that you need for a tech project, from the, you know, wireframe to the architecture to all of this other stuff, they were able to help. This past year has been such a learning experience, but the Zertane team was uh, so integral with asking those questions questions so that we would have a good output and a good MVP and a good product. Um, and we learned a lot of stuff on the way, but every single time it was like, no problem. Um, and also, um, Zertain introducing the Caspio product. With Zertain, understanding where I needed to be when they're like, here's your product. You know, handing it over to me that it was something that I could run and that I could manage, um, for my team. And then it wasn't just a. Okay, I'm in the dark with all of this background code that I didn't know anything about. So. So, um, Caspio has been great in that essence of now I can go into the platform and like, okay, I can understand, like I understand how things are put together and how things are working. So full circle. That's how we met Zertane and also how we met Caspio.

Speaker B: Great. It's always get really good to get a referral, especially with something like this, as in with Pavan. And I met with Pavan recently and um, we had a really good conversation. And the mindset of him, which is 100% right, is that when he's talking to potential customers, is looking for what that pain point is, what is that? And then working backwards from that, or what is somebody looking to achieve and then working backwards from that. So it's a great thinking, um, process that Zyrtein have. And I know many of our customers that work with Zyrtane are very, very happy. So that's good to hear. So from your side then, Samantha, just kind of switching gears a little bit. For those that are not aware, can you describe the complexities of the medical denial system, um, from the patient's perspective?

Speaker A: So a lot of times, so people sign up for healthcare and it's your healthcare, it's your insurance benefits that you pay for as an individ individual. And, um, to compete, you know, commercial Medicare, Medicaid, and with all different plans, there's federal rules, there's state rules, there's multiple insurance companies, and all of those have different rules. And you know, so it becomes like, it's not like you just go to your friend and be like, oh, yeah, I've had that happen before, you know, or, um, you know, or relate that experience because somebody, you know, might have the exact same insurance company and theirs got paid and yours didn't. And then also we've had this sort of, you know, additional barriers in healthcare that has worn people down with trying or not knowing what information to provide in an appeal. Um, and so that information, or with the prior authorization, and that goes from providers and um, from patients as well. And those are barriers. And so it's a, it's exhausting. It's exhausting. You know, as a, uh, being in the healthcare sector, it's exhausting seeing that for people. Um, myself, I've experienced it, my family's experienced it. And I'm like, it's okay, we'll appeal. And it's still though, where do you find that information? There's not really anybody to help with that. And when you call, you Know the insurance, it's like, well, you know, your health plan guidelines, like, what does that mean? Most people I talk to, they're like, I never looked at a booklet. Like, I have rules. Like, so it's, um, a huge pain point in knowing just even what you signed up for. Um, I think we've talked previously, it's like, you know, if you were denied an mri, would you know, like, what your coverage is? What your coverage is when you signed up?

Speaker B: Yeah, it's like I said when we spoke earlier, I think it's a great idea. So the application that's been created, um, what gaps is that gonna fill in the healthcare, um, insurance process?

Speaker A: So with this. So, um, to help people that they can come to our application if they received a denial, they don't need to have a background, um, in healthcare or in medicine. Um, I asked my dad to be a tester. He goes, well, don't you want like, somebody else? Like, you know, who's healthcare? I said, no, I want you. I want a user who wouldn't know anything about, um, a system or whatever and log in and use the application and test it out. And so really a, uh, basic user that will help prompt them, ask them some questions, and then produce, um, a really good appeal letter to increase their chances of winning. Because most people also don't know this. You have a very high percentage of overturning that initial denial. If you just appeal, um, there can be considerations that may not have been considered before. You might be providing that piece of information that you didn't know that they didn't have. There's also an assumption that things go to the insurance company and they have all this information, which they might not,

Speaker B: I think, like I say, super smart from, from my side. So from, From Zirtane's perspective. Cameron, how did you go about translating all this knowledge and experience that Samantha has and obviously her vision as well, and then turning that into an application?

Speaker C: There, ah, there are a number of things that we had to take into consideration throughout the requirement. Gathering, design, um, and, and, and so, and solutioning, um, process. The first one is Samantha doesn't have a large tech team. So it made sense that we lean into composable, um, platform. Composable, uh, platform, that being Caspio, uh, no loco, no code. Um, there are also a number of other challenges. We're dealing with the healthcare sector, so we're dealing with a lot of pii, um, a lot of data that's very, very sensitive. Um, and on top of that, we had to make a Platform that was user friendly. Um, it was, had to be a web application. Um, and there are a number of other additional features around, um, payments and processing and user management. Making sure that we're actually um, presenting the right information to the right person with the right profile. Um, and then storing that and making sure that the PDFs and all the information that is captured is stored in a secure way. Um, we mentioned HIPAA compliance as well. We had to check that box and we had to make sure it was scalable and secure at the same time. Again, housing a lot of um, private information.

Speaker B: Yeah, I think it's um, bringing you two organizations together has just been a great fit. I think it's um, from what I'm hearing from the experience perspective and the process that Zerten went through and from your side then Samantha, has your vision been delivered from kind of what you were thinking from at the very beginning to where we are today?

Speaker A: Absolutely. And it allowed my vision just to get bigger. Um, but uh, no, Cameron's right. It was a. One of the things was, is scalability and security. So again like we talked about in the beginning, there are not a lot of products in the healthcare consumer spec like Fintech. You know how Fintech took off in the 90s and 2000s. Um, you know there's a lot of barriers to that currently in the United States. And you know, with that, uh, we want to do it smart. So we're anticipating what could regulations be, what could, you know, doing all the things and making it secure from the beginning and setting that precedence um, for that space moving forward so that our company is at the forefront of that. Um, so it's been fantastic, um, and the exceeding expectations from Zertain. Um, I met with the team this morning and they brought me something and I'm like, this was beyond what I was expecting and I appreciated it. And they're always helping me ask the next question as well, if they haven't already asked it, um, before I've asked it.

Speaker B: Oh, it's great to hear. So during the process then, has there been any, um, surprising discoveries as you've been going through, um, the whole process, the build process?

Speaker A: Um, I, there were, but you know, I can't think off the top of my head. I do know at one point in time there was a part in the process, um, where I went, you know, what we got here because I didn't. It was essentially for my lack of experience, um, of going, oh, had I, you know, been in this space a little bit, we wouldn't have gone down this little pathway and we did have to reverse a little bit. It had, oh, I remember it had to do with, um, the ui. I had a, I thought I had a vision of here's how I want the ui. They drafted it, they put it all together and I was like, yeah, this isn't, this isn't going to work. This, this doesn't look good at all. Um, don't listen to me next time on this one. Like, um. And so, you know, we had to pause, we had to roll back. It did add some time to the project. Um, but again they were, it wasn't a problem. They were, you know, okay, we can pivot. It'll take a little bit of extra time and you know, here's how we can pivot. And here. And it had to do with how custom it was, how custom of a build that it was, um, to make that pivot and change. But it was worth making that pivot and change to make it more user friendly in the end.

Speaker B: You mentioned how, uh, cumbersome it is for the appeals the way it is today. If people want to appeal things, how does the app make it much simpler for the user?

Speaker A: So currently they can go through, um, the question. So right now there's really nothing out there. They can call and then write a letter. And again, when people are writing letters, what information to put in there. They can Google on the Internet and maybe find if somebody put a template out there, but that doesn't really scale to their situation. So we lead them through some questions to help, um, for their particular situation. Um, and our current MVP is, you know, a very basic model and we are going to scale up to an AI model that will get even more specific. So that's to come. Um, but our just current product that is out there, it doesn't need AI right now. Somebody could come in with a medical necessity denial or a co payment denial, um, or coinsurance denial where it's like, hey, I shouldn't have been charged $50, I should have been charged $25. And we'll walk them through that to make a very tangible letter and increase their OD of winning that appeal. Um, rather than, you know, just a angry call to the customer service or, you know, I've, I've seen some interesting letters out on the Internet, um, put interesting ways where it's just a, trying to get prompt questions to get that right information to get them that win. Um, outside of that emotional frustration of going, having to go through that being a helpful solution for them.

Speaker B: Yeah, um, so from your side, then, Samantha, what makes EZ MedAppeal? The application, the first of its kind.

Speaker A: So again, it's really about that consumer. Um, most times health insurance companies, um, will pivot to the physicians. It's assumed that, um, providers should be doing the appealing. However, again, it's your benefits and as the consumer, it's actually your appeal rights that you have. So if you're trying to get a pre authorization for something and if something's denied, many times the process is, is that the provider submits the information, orders it for you, just like you, um, and sends the information to the insurance company and it's processed. But then once it's denied, that right goes to the member to appeal. It's in their benefits, it's their right to appeal. And so some providers, some providers don't have the staff, um, the bandwidth. They don't get paid to do appeals or, you know, any of that extra administrative work. So this administrative burden to try to get prior authorizations and claims paid once they're denied has sort of, the industry has sort of shifted that to the providers and then sort of left again the consumers, the patients in the middle. And when really it's their benefits, it's their rights, um, and they suffer. You know, we hear about those huge bills, right, People getting stuck with these huge bills and what do you do about them? So, um, that's really that market, that niche market that, uh, to be helpful for consumers.

Speaker B: Yeah, thank you for sharing that. And you mentioned a few minutes ago about the appeal letters. I know the application personalizes those appeal letters based on insurance types and denied services. How does it do that?

Speaker A: So current state, um, we have it by category. Um, again we build. Just wanted to get something out there because something doesn't exist. And so again, it's by the type of denial, if it is like a general medical necessity denial, if you received emergency services, um, but maybe it got denied because they didn't flag it as. That it was emergent. Right. It processed incorrectly. Um, and so a lot of these common scenarios, we started with some top common scenarios, again, that people could come out, answer a handful of questions and then within 10 minutes have a letter and, and be ready to mail it out. Um, one of our current upgrades that we're working on with Zertane is to be able to do the auto mailing. Um, but we're not there yet. That is on our, one of our upgrades. So right now it will give somebody a PDF they can print off or they could download their PDF and upload it to their portal, um, or you know, attach their medical records to it and send it off to their insurance company, um, to get their appeal.

Speaker B: Super smart. Um, so from a feedback perspective then Samantha, how are you gathering feedback? Or have you not started to gather feedback from the end users yet?

Speaker A: So right now we are still scaling up. So we just um, launched a couple months ago. And so I think like with anybody who launches a new product out on the Internet, um, it's a little, it's really getting the word out there that this product is available. So it's that new space and we've had a lot of site visits, we've had a lot of like, I start to see that every week I start to see the traction pick up a little bit more, a little bit more. More people starting to reach out. I had somebody reach out last week, um, and email us and it's like, hey, I have this unique situation like you know, can you help, uh, can you help me out? And also providing more information on our site, um, adding that education component as well as the application component of like yes, you can appeal these things. You know, here's, here's information on um, how you can do that. So um, and then also with um, we're always searching feedback so you know, looking for those initial testers. And starting hopefully next week we're going to turn off the payment gateway tool completely just to get more of that user feedback, get people in there, um, and see if there's development improvements that we can do from the UI aspect and user ability.

Speaker B: Yeah, and I know um, from talking with you Samantha, Appeal Technologies is proudly female and veteran owned. Why was this kind of an important statement to make sure that um, it helps your brand.

Speaker A: So I think you know, as far as, you know, females, um, and in tech and just really the, you know, empowerment and even coming from the health care space that it's a, you know, I feel as like a health care provider, like I've worked with, you know, in projects, um, many times, you know, as part of some of the first EMR rollouts. And you have these big companies come in to be a part of that and like you're a user but like they've already got, the tech folks already have an idea of what they think you want. And so really coming in from this aspect of like, here's what's, here's what we need, here's what's needed in this situation and more of reversing that and getting a product out there that is helpful for people, not just what a big tech company might think is helpful or here's what we built for you. And here you go.

Speaker B: Yeah.

Speaker A: So, um, and my husband is a veteran and so when I came to him with this idea initially, like, I woke up one day with, you know, like, hey, we're going to make a tech company. And he's like, okay, this is what we're going to do. Uh, you know, he's a veteran and you know, again, um, from people, whether they have, you know, um, their healthcare through the military or not being able to um, offer them assistance and help, um, it's, you know, something that's fond and close to my heart with helping um, our military as well with anything. So we do like to put that out there that um, we support them as well.

Speaker B: Yeah, it's great. And from your side then, Cameron, obviously, uh, going from the initial vision with Samantha to where we are today and obviously the future, what that's going to hold in terms of the development of the application. Was there any, any challenges or concerns that you had during the initial conversations? Obviously, throughout the build. It's such a highly regulated and complex environment. The healthcare,

Speaker C: I think out of the box. Caspian solves a lot of those regulatory and compliance issues that you'd lean into if you were building a traditional full stack application build. Um, so, you know, take that off the table. That was. We whizzed through that. Um, the great thing about the platform being ah, uh, low code, no code is that you can iterate, you know, when you build an application. Um, you know, if you were doing a traditional waterfall approach, you'd spend, you know, weeks and weeks and weeks making sure you got every single requirement and everything buttoned up to then translate that to a developer and a developer would then code that and then you might see something in a few months and that's not the case here. So I think, um, being that we've been able to iterate, we've been able to experiment, we've been able to um, try things without breaking anything, um, and still progress quickly through uh, the productization. Because we're building a product here, um, process. It was really great. M. And that's something that we enjoy as developers is seeing uh, the co vision between Samantha's vision and our ability to come to light quickly.

Speaker B: Yeah, thank you for sharing that. Um, so from your side then, Samantha, if anybody is thinking and considering using low code or Caspian or even a partner like Zerten, what advice would you give them?

Speaker A: Oh my gosh. Um, I, I love that the low code no code tools exist. Um, because prior to doing this it's like um, I hadn't had much exposure. I had a little bit of exposure, um, not with the Casio tool specifically but learning you know, over the past year, um, about this and again somebody who doesn't have that specific IT background but then you know, you can get into that space. I am just blown away that you know, the products exist and then to be able to turn something around and again use it, um, even from, you know, the back end and understand it. And one of the conversations I had with pavan last month because we talked about the user experience, like with the last question we were talking about and I'm like, you know, like I, I don't know yet if this is it. He goes, that's okay. He's like, because we can. Now that we've got the base, he's like, we can turn around and give you a second version or a third version. We can do A and B and launch them both and it's not going to be, you know, as much work at all. So we could do you know, two designs if you want. You know, Samantha. And I'm like okay. And I'm like. And you know we've talked about add ons that we want to do and it's just like yeah, like all of this stuff, you know, once we get the initial, you know, structure around, you know, we've got all the base elements there and now we can start to add the other components. Um, I am, you know, anybody's who's looking at, you know, these types of things. It's like absolutely, um, really user friendly products.

Speaker C: Yeah.

Speaker B: And then from your side then Cameron, um, if somebody's considering working low code and especially a partner like Zerten, what advice would you give them?

Speaker C: I think um, I think it's important to understand uh, the vision um, and the prioritization of real requirements. Um, it's great to sort of do everything at once again. You know, start with what you'd consider to be an MVP and what components are in there and know that you can, you can achieve that quickly and uh, efficiently and that'll allow, allow you to learn a little bit, feel out your project, um, and then you can iterate upon that um, without really painting yourself into a corner. So sometimes people get caught up with um, you know, the whole project going, you know, going from A to Z. I think it's good just to look, you know, A to F or A to G, um, and chunk it out a little bit and know that, you know, you're not going to be, um, you know, developing down a path or, you know, you're literally configuring something that is flexible and agile and can grow with your creative, uh, mind, as it were.

Speaker B: Some great advice. Thank you both of you for sharing that. I'll add the contact details to both of the companies onto this podcast as well. So if anybody's got more and want to learn more about ez, um, med appeal, they can come to you, Samantha, and to your site over there and obviously to speak about zerten and support from a partner and they can come to your team as well, Cameron. So, um, we'll put all the contact details on this screen, um, for everybody as well. So lastly, thank you both of you for joining, um, Caspio's podcast today. I think it's been a really interesting conversation. I'm excited to see where this application is going to go and also the impact on the healthcare system that I'm sure it's going to have. So thank you both for your time. We appreciate um, your business, Samantha, and um, you being a gold partner as well. Cameron, thank you very much.

Speaker C: Thank you, Tom. Paul. Thanks, Samantha.

Speaker A: Thank you, Paul.

Speaker B: To get more information about our low code platform, please visit caspio.com and visit Ah, our YouTube channel to learn more. Bye for now.