Ep 172: Navigating the Cost of Your Fertility Journey with Dr. Taraneh Nazem, Carissa Simek, and Ben Howard
Fertility Forward Episode : 172
Insurance coverage, healthcare benefits, and navigating the fertility journey from a cost perspective are incredibly important topics of discussion. Today on Fertility Forward, we welcome Dr. Taraneh Nazem and Carissa Simek back to the show to share their perspectives on this issue, as well as the co-founder of Sheer Health, Ben Howard. Tuning in, you’ll hear all about what Sheer Health is, how they alleviate financial and logistical pressure from both the patient and the doctor, and the importance of taking advantage of healthcare benefits. We delve into how Carissa tracked the financial side of her own fertility journey before hearing all about exactly how Sheer Health works for both patient and doctor. Finally, Ben tells us about his personal journey with fertility, how to access Sheer Health, and we share what we’re grateful for today. Thanks for listening!
Rena: Hi, everyone. We are Rena and Dara, and welcome to Fertility Forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our Fertility Forward podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients, because knowledge is power, and you are your own best advocate.
I am so excited to welcome all of you to Fertility Forward today. I have three amazing guests to share very differing perspectives on something that is so important, which is insurance coverage, healthcare benefits, and navigating the fertility journey when we're thinking about cost, which unfortunately is often such an issue. So on today's episode, we have Ben Howard, who is the co-founder of Sheer Health, which is an app which helps patients and providers navigate insurance and the financial side. Carissa Simek, who is a patient of RMA who well documented her egg freezing journey and has been super vocal about it. And Dr. Taraneh Nazem from RMA, a reproductive endocrinologist and also Carissa's physician. So thank you all so much for coming on to share your perspectives on all of this, which I think is such important information.
Dr. Nazem: Thanks for having us.
Ben: Yeah, thank you.
Rena: So let's dive right in. Maybe Ben, do you want to present to us and let us know what Sheer is and how it benefits patients?
Ben: Yeah, absolutely. So I started Sheer Health initially as a straight direct-to-consumer healthcare company. Understanding health insurance, healthcare, medical billing is unnecessarily challenging. And there was just nothing out there that helped me personally or other people to easily navigate all decisions regarding benefits, care, and health-related finances with confidence. So at Sheer, what we do is, just like you connect your bank account to Venmo or PayPal, you connect your Aetna, Cigna, United, whatever insurance you have to Sheer. That includes Progyny and Maven and other fertility-related platforms and we help our members to be knowledgeable about their benefits, really be confident in getting the care they need when they need it. And both either be protected from an erroneous or inflated medical bill. Perhaps your name was spelled incorrectly or your date of birth is wrong. So you get this big lab court bill and you're not sure if you should pay it. We fix that. More importantly, if the bill is correct to pay, let our members know, you know, heads up. The $300 bill is a responsibility for your June 7th. So it's really helping people get the care they need when they need it without having to do with their health insurance again.
Rena: Well, and I know, and Carissa, you can speak to this as a patient, Dr. Nazem…right now, the way fertility clinics on the whole are set up is you deal with a finance coordinator and they're the person that they tell you, okay, this is what you can expect from your bill. This is what's going to be covered. This is what's not going to be covered. But so often patients get differing information, which leads to so much frustration. It can lead to a ton of stress. You know, I thought I only owed $500, but I'm getting a bill for $5,000. Then they take it out on the clinic, they get confused, they then have to spend all of their time calling up insurance, trying to get in touch with the clinic. And it's just so exhausting on top of a process that's already exhausting in itself. And I think, you know, it sounds like this app is really serving to make everyone's lives easier, both from the patient perspective, as well as the physician or the clinic, because they don't have to sort of be the go between.
Ben: That's exactly, exactly right. I mean, we do work with a number of large fertility clinics today and historically, it's an emotional journey when you're trying to understand what's covered, what's not covered, how much am I going to have to pay? Can I afford IVF, IUI? And one of the things that we do, we take care of all of the benefits verification. So the patient can just focus on scheduling the appointment and turning up and receiving care. And the providers can understand what is covered for this patient. Do they have, you know, $30,000 they have three cycles for IVF and what we've been able to do is really simplify the journey for the patient, let them focus on just getting the care. And on the clinic side, they no longer have to call the insurance company and wait on hold or hope that the patient remembers that they've got a Progyny or a Maven benefit or that their employer provides egg freezing or elective egg freezing benefits and it's really both simplified the process and enabled patients to get to their appointment quicker and have the treatment they need quicker and allows the clinic to better understand great, this patient has this type of benefit or they've switched jobs mid-cycle and we update the clinic to let them know that the new employer actually has a fertility benefit or doesn't have a benefit and they now need to think about what's the best financial plan for the patient.
Dr. Nazem: Yeah, this is like probably one of the biggest pain points in the whole healthcare system, not just in fertility medicine. And, you know, I think that RMA of New York has tried to solve this problem by creating an entire financial department with a financial coordinator that is dedicated to each patient. And while it does definitely help, there are still so many little cracks that things fall through. And I feel that like, Rena, you said it completely correctly. This is just like one more added layer of stress and financial problems are extremely stressful. And even if it's just for a minute that everyone's heart sinks when they get that huge bill and they're just not certain where even to start. So it is nice to have an additional resource to just cross-check things. And, you know, I think one of the biggest challenges we've seen is that also just silence from the insurance company is painful. Waiting all that time to just get feedback on a specific item or will or won't this be covered or just not being able to necessarily get intelligent information is exhausting. And I mean, just because I work in this world doesn't mean I get it either. I struggle with it myself. So I think it's great you've created a company that really addresses this major issue in the healthcare system. I don't think it'll ever be perfect, but it's helpful, especially like you're saying, when there are major changes that have happened in the middle of treatment, like a new job, a new enrollment has happened, you know, like waiting for benefits to kick in and all that kind of stuff.
Rena: Well, and I would say to you, Dr. Nazem, too, how much, so your job, you're a physician, you're not a finance person.
Dr. Nazem: And I make that abundantly clear to my patients because I'm so bad at it. And I have an entire department of people and a team myself that is wholly dedicated to it because it's so complex and it does take a lot of back and forth. What we like to do at every single initial consultation, so when I meet somebody for the first time, that visit also includes a financial consultation so we can a initiate the process that's needed to figure out what is covered, because that's a big barrier for people, particularly for egg freezing or embryo banking, which a lot of insurance companies consider is, quote unquote, elective and therefore doesn't have a medical need and therefore will not necessarily always be covered. So it is so valuable to have that checkpoint. You know, I'm sure with Sheer, that's something you could do even before you come and see me to make sure whether or not this makes sense to even entertain for you. And then my finance team can help to figure out if there's payment plans that would work or other ways that we can kind of skin the cat to make it feasible. But I know this is a big piece to something that I have partnered with Carissa on that since she did her first egg freezing cycle, I think it really opened her eyes to the benefits, but also the complexities of the system. And so she and I have spent a lot of time giving talks and all different kinds of forums to people about if you have benefits, use them and this is what they're for. But also go and talk to your companies and find out what you have benefits for, because unfortunately, it's sort of a disservice that a lot of companies provide the benefits, but they are not vocal about it. And so a lot of people are not aware that they even have an opportunity that they're not taking advantage of.
Carissa: Yeah, I think that that's a huge part of it, obviously being vocal about the benefits, but also when you get in the thick of it… I mean, I talked to the financial team at RMA and it still took a moment in time for the insurance companies to approve me, to get me started. And so even with additional resources, it can just take a moment. So I think that that's important to say. And then I think also, I mean, when you're going through this, We all have full-time jobs, like this is something where I remember specifically with like anesthesia reimbursement, I was on the phone. I couldn't even count the hours. I was talking to this like third party thing to talk to someone else, to talk to someone else. And I finally emailed, I don't even know who it was. It was like some SVP or someone that worked in our benefits office and I was like, I just hit a roadblock. Like, I don't know what to do anymore. Like I can't keep spending hours on hold. And then when they give me a call back, I'm in a meeting or whatever it is. And so I think that's a huge part of it is having someone to help you do that legwork because you've reached so many barriers and you need people from all angles to try and help you get through this. And so there's a lot of benefits, I think, with having someone like Sheer.
Dr. Nazem: For sure. Totally. And I mean, that's not for the faint of heart. How many people could you imagine would just drop the whole thing at that point? Just be like, it's just not worth my time. I don't care. I'll freeze my eggs. I won't freeze. I mean, obviously there's so many amazing benefits to doing these things, but you can imagine how awful it is also when it's not an elective decision. It's, you have a medical condition or a reason that you need this treatment and it feels time sensitive because it is because fertility is. And then to have these kinds of big roadblocks derails you. It can dishearten a lot of people from pursuing what they need. So I think, you know, we need problem solvers like you, Ben. So it's great you're giving support in an area that is, it's prickly. It's hard.
Ben: Yeah. I mean, I think you both really hit the nail on the head. I mean, I personally have three kids through IVF. My wife and I went through a very frustrating and complex journey. We started Sheer to essentially address that to both of your points, just understanding what's covered, what's not covered, what benefits do we have. And at Sheer Health, when somebody signs up, the first thing we do, we provide a really detailed but easy to understand benefits report where we let them know, did you know you have infertility coverage? And then we go a little deep and we let them know, what does that mean? If you're under 35, you have to be trying for 12 months of unprotected sex and then if you can't get pregnant then your plan would cover x if you're over 35 at six months and even you know what benefits the employer has because sometimes i think to Carissa as you said you just don't know and some employers offer really great benefits it's you know they offer regardless of a diagnosis, elective egg freezing, others it's if you have infertility and what we've been able to do is in that emotional time sensitive day week month leading up to a visit or a procedure you know you're focused on i got a you know, do the progesterone at this time of the day because I have to do it, you know, every day at the same time. You're not thinking... oh, is my insurance going to cover this? Do I have it covered? So Sheer health really helps people just focus on their care journey without worrying. Do I need to wait on the phone with insurance? And we've had it many times where insurance company will tell a patient something, the patient goes and gets the care, and then the claim gets denied because what's the first thing the insurance company says? Well, whatever we tell you is not a guarantee of benefits. It's a really crazy system. So what we do is we kind of take all that legwork, both of the patient and the clinic, and allow the clinic to build the best care plan possible whilst understanding, does this code require prior authorization? Does this code have a cycle limit or a benefit limit? Does this plan allow for embryo banking where if you've had a successful retrieval, can you do another retrieval, you know, right afterwards to maximize the woman's chances of a successful transfer? And, you know, it can be really frustrating for both the clinic and the patient. So, you know, nothing really existed that helped people navigate the complexity of the 300 page medical booklet or the nuance of you need an infertility diagnosis versus, you know, I'm a woman of a particular age and I just want to freeze my eggs. Not for any reason, just because that's what I want to do. And if I've got a benefit, you should really use it.
Carissa: Yeah. It's interesting. You mentioned the code part of it. I mean, I don't have a medical background, never, you know, claim to, but I was doing something with billing and they were like, we need all of this coding information. We need this code and this code. And RMA sent me like I mean, they were so great. There's something like all of this stuff that I needed to pass to someone else to pass, you know, whatever this chain of command was to like help me get these bills sorted out. But I was I didn't even know what I was looking for. I was just like, oh, I guess I need X code to show whatever it showed to help me with the process. So, yeah, it can be incredibly frustrating for sure.
Ben: And America is a system where the person in the room getting the care and the person in the room giving the care is not necessarily the person paying for the care. That's the insurance company that's not even in the room. So it's kind of almost criminal when the doctor says there's a clinical need for this patient to have this care and the insurance company will say, sorry, we don't think that's clinically necessary. But it's like, wait a minute. I'm a patient. I'm paying my premium to my insurance company to get the benefits. A doctor with significant experience has said this care is medically necessary. And some random person in an office says, sorry, we don't think that's medically necessary. So we see that all the time. And what we can do is we help both the provider and the patient where we will then put together an appeal case, submit it to the insurance company and say, well, actually, you know, this embryo transfer is medically necessary or this IVF case cycle is medically necessary. We'll show how and why. And oftentimes, most people give up. I think as Dr. Nazem said, most people just give up at the first step because if you're at a full-time job or you have kids to juggle or you're just going through the emotional journey, you don't have the energy or the time to really fight because you're focused on taking your medications or you're getting prepared for a cycle. So what we found is by being able to take on that burden or that frustrating experience of whether it's just putting together an appeal case and putting together all of the super bills and the sonograms and the blood tests to show that, yep, this patient does have a diagnosis of female infertility and this care is needed and it is covered under the plan. So we've been really successful for thousands of patients and a lot of the clinics that we work with of helping to just overcome that first barrier because insurance companies, whilst some of it is 100% legit, people getting cosmetic care or elective care that's not covered, totally understand when they deny that. But when it is care that's medically needed, it shouldn't be denied by a person that doesn't know the patient and doesn't understand why the clinician is saying that this care is medically necessary.
Rena: I mean, I think share is beneficial on so many levels. And, you know, Dr. Nazem too, it's like, how often do you get a patient's misplaced anger that they're blaming you for all the mix up with the finances and it's taken out on the physician, right? And so I think this is, you know, can really help on both ends, you know, patient and physician. So it can let a physician be a physician and it's not your fault what's going on with the finances.
Dr. Nazem: It's just, I mean, it's hard enough to have to even come to my office to need anything from me and to have to struggle with something that most people just thought like, oh, it would just happen. You know, fertility is very frustrating in that, you know, you just lack control, any part of it in your life. So I think it's already, we're already starting at a pretty high level of frustration. And then, you know, with anything that is a hiccup along the way, it just, it grates at everyone's patience and nerves and just makes it harder to then provide really good care because as you know, Rena, very well in what you do, that it's very much a holistic approach and the sort of mental wellbeing of somebody goes hand in hand with the like medical care that I'm giving. And it's very hard to persist through multiple rounds of treatments, which often people need when just things just aren't going your way, whether it's the medical results, the insurance coverage, the financial burden, all of that. And each one of those categories, everyone takes a little hit. It is always going to cost a little bit more than you want it to. It's always going to not go as smoothly as you want it to because nothing in life is a direct line. And, you know, it's just like if we can minimize that in any way, then I think we're winning. And then we can really focus on truly hard and what really needs to be addressed and fixed.
Ben: Yeah, I mean, I think you said it really nicely that even if you deliver the best clinical care you can, and it ends up being a positive result, if that patient gets a big bill that they weren't expecting, they can forget how great the clinical care at the practice is and now they're just mad because they got a bill that either they weren't expecting, or maybe the bill is not right. And as you know, I think, as Rena said, everything's been placed on you, when it's not your fault that the insurance company by mistake denied a claim and sent a big bill to the patient. And you know, we see that a lot. And I think, you know, just in general, one of the leading indicators of a malpractice lawsuit against the medical profession is, was there a billing issue or a billing dispute? So it's almost, if you can remove that piece of the process, then just the patient experience is that much better. Because if you've delivered incredible quality of care during the clinical process, it's not your fault that a bill was sent that was denied or the insurance company didn't cover as much as the patient thought, but that's what sticks in the patient's mind.
Dr. Nazem: No, what's fascinating is by doing a lot of these educational sessions at different companies, it's opened my eyes, even though I do this all day long, opened my eyes to just how even some of the best insurance companies and benefit groups are still, it's not like a direct, easy, you know, plug and play kind of thing. And so at most of these educational seminars that I do, and I've done a lot of them with Carissa, we always have somebody from the benefits department join so that they can explain what needs to happen. Boy, is it still complex! And like, employees need to still be educated on how you even sign up and release these benefits, like unlock them for yourself. Already, that's phase one before they've even walked into my office. And then once they unlock them, all of the other paperwork and requirements and things like that. And this is with the companies that provide, I'd say, the most streamlined, easiest benefits. And like you were mentioning, like Progyny and Maven and Carrot and this and that, it's still not easy. So it is always helpful to have a guide on this insurance tour, if you want to say, because it's still not going to be the easiest if you do have anything else going on in your life and this is not your sole purpose.
Ben: Right. And as you said, it's really confusing. Even if the HR and benefits team let you know, because we've seen across kind of the spectrum, you can have like a wind fertility benefit. If you don't call the nurse to start your case, you only get $12,000. But if you get on the phone for 10 minutes, it's now $30,000. Or, you know, you certainly have got Do you think you've got fertility covered? Great. But you didn't know that you can only get the medications filled at Freedom Fertility Pharmacy or Credo or Express Scripts. So you can only get the medications filled at a certain thing. And if you pick them up from CVS or Duane Reade, sorry, they're not going to pay for them. And now you're paying tens of thousands of dollars.
Dr. Nazem: It's wild. Like, why do you need an insider to help you to get something that you already do? But you do. And that's just the way life works.
Ben: Yeah. Even when they make it easy, it's not easy.
Carissa: Yeah,
Dr. Nazem: Totally. There's all these loopholes.
Carissa: When we were having one of our last conversations, Dr. Nazem and you and I were speaking, someone approached me after and was talking about the medical and the bills I was getting and all this. And even then, I mean, I kept a spreadsheet just because I was just-
Dr. Nazem: Because you're organized.
Carissa: I'm a little type A, we can all agree. And- just like how much the bills were coming through and what it looked like. And then I would give, I mean, I openly would share it with people that were interested. Cause I was like, if it's, you know, if it's helping someone understand or open their eyes to what might be coming down the pipeline. Great. But even so they were like, Oh, interesting. Like, I didn't get charged anything for meds and I see you got charged X amount. I'm like, I don't know. Like, I don't know, but this is just what it is. And so I think even then there's still stuff happening where Ben to your point, if you're calling a number, you might get X amount more versus not. I mean, it's just a complex system. So I think it's that, I mean, it's just absolutely complex for sure.
Rena: Yeah. So Ben, tell us, I mean, any future implications or where do you see Sheer going? I mean, I'm such a big fan and have sent so many patients away because I think, you know, I wish I had shared when I was going through my fertility journey, it would have made everything so much easier. And, you know, I day in, day out, you know, one of the biggest stressors for my patients is finances.
Ben: Yeah, no, I mean, first of all, we're extremely grateful for the trust that you place in your patients, place in Sheer Health. We are expanding, particularly in fertility or in fertility care, simply because that's where a lot of the challenges are, whether it's like Carissa, where elective egg freezing or egg freezing is becoming just a bigger need or desire for female patients. So we kind of do a little bit of everything. We help people before, during, and after they go to the doctor. So for a lot of clinics, fertility clinics that we work with, when the patient first makes an appointment, they download the Sheer Health app or they go on to SheerHealth.com. It's totally free. And they connect their insurance. And then we do all the work. We do the benefits verification check for them. So we provide a really detailed but easy to understand overview of, do you have infertility benefits or fertility benefits? And what is all of the associated information. If you need to register or enroll with WIN Fertility or Maven or Carrot or Fertility Solutions with United Healthcare, we let you know the difference between what fertility benefits mean and what infertility benefits mean, because those are two big things. And sometimes people get confused and then that could end up costing a lot of money if you make that mistake. And then we also share all that information with the clinic. So now the patient just turns up to their appointment. The provider has all of the information they need to say, this is the care plan. Oh, and don't worry, you have $30,000 of infertility coverage, and you can not only get the IVF full cycle, but your medications will be covered too. And don't worry, we know that we have to send them to this specialty pharmacy. And then kind of once the care is happening, we also let our members know all of the additional benefits. You know, if a woman's going through infertility, they need, you know, or potentially need mental health care. So let them know what their mental health care benefits are. If they've got acupuncture coverage, some women like to have acupuncture as part of their infertility plan, or whatever that might be. And then we handle all of the claim submission. So for providers that don't accept insurance, we will review the bills, make sure all the correct information is on there. We submit that to the insurance company and make sure all of the reimbursement goes back to the member. So now the patient can really focus on getting care they need without worrying, am I going to overpay? Am I going to get money back? Is the money I'm getting back the right amount? And then if there are any issues, we flag and fix those proactively for members. So it's really about removing any need for anyone to ever deal with their health insurance again. And really just focusing on the procedure at hand or the care journey at hand. And we also do things like we'll help lower eliminate out-of-pocket costs. So if there's a way to lower a prescription cost for a Menopur or a Ganarelix or a Follistim or a Luprolide, we'll do that for our members. So it really is about how can people just get the care they need when they need it. And the same thing with doctors too, because we see a lot of doctors, either they accept insurance and they're still challenged with that, or they don't accept insurance and they don't want to deal with it. And we take care of that too. So we work both for providers and for members.
Dr. Nazem: Needed in both directions?
Ben: Yeah. Insurance companies don't make it easy.
Rena: No, they don't. Well, we're so grateful for you. And Carissa had to hop. She had to go back to her real life. And I know Dr. Nazem has a patient waiting. So really quickly, I wanted to conclude with a message of gratitude to something that you are grateful for today. We'll do it a little backwards and then Ben and I can really conclude the episode. But before Dr. Nazem has to hop also, something that you're grateful for.
Dr. Nazem: Thank you both so much for including me in this discussion. Ben, it's been exciting to hear more about what you've provided on the Sheer Health platform. And I imagine that I'm going to be sending a lot of people your way. But I, you know, I'm just so grateful for all the energy and effort that all of you have helped to provide to get patients through what's a really difficult, but such an important journey. This really, it does take a village. It is not just a one person operation to see somebody through from beginning to end with any kind of fertility treatment, whether it's elective or it's medically indicated or whatever it is. And so it's nice to know that, you know, we have smart people coming up with creative solutions where they see problems and wonderful people like you, Rena, who are giving the mental health support that people really need And, you know, it goes beyond just my team at RMA. So really grateful for that. And happy to have this now broadcast to the larger public so that people can learn more about it.
Rena: Well, you're amazing. So appreciative for you. I know your patients are so grateful. You're wonderful. I think you're a physician that really just gets it. And so, so amazing to work with you. And thank you so much for coming on.
Dr. Nazem: I feel the same way. And Ben, let's hope this is the first of many. Okay?
Ben: Absolutely.
Dr. Nazem: All right. I'mgoing off to patient care land.
Rena: See you later. Okay. All right, Ben. So then there were two, you and I. So something that you are grateful for.
Ben: Yeah, I think that as it comes to just our interaction with healthcare and health insurance day today, I'm just extremely grateful, I'd say, for the perseverance and the patience that healthcare providers have. I think you take for granted as a patient when you walk into an office and you get seen and you get care and that's it. But what we see behind the scenes is the sheer amount of work and hoops and bureaucracy that doctors and admins have to jump through to either understand the benefit for a patient to get a claim processed, to get paid, to fighting when an insurance company says, we don't think that strep test that you gave this patient was medically necessary. So just really grateful for the healthcare professionals in general for turning up every day because the walls that they hit and the barriers that they have to go through can get really, really frustrating and painful, yet people still do it. And healthcare is not being made easier in this country. If anything, we see it's just becoming more complicated and more complex. I'm just really, really grateful for the doctors, the nurses, the PAs, all the mental healthcare providers, everyone that turns up every day and treats patients and then will deal with whatever comes from the insurance company or from a patient when they get angry. I took that for granted when I was just a patient, but now we see kind of a bigger landscape. I think it's incredible that people turn up to a hospital, to a doctor's office, to an optician, to a pharmacy every day and go through what they go through.
Rena: Beautifully said. Yeah. And we're so grateful to have you in this space. And I think you had probably told me prior, but I forgot until we reconnected today, that you also got into this because of your own experience. And, you know, listeners on our podcast know so many of our guests come on and they've created something because they went through this and saw there was a gap in space. It's how I got into this line of work. It's how Dara, my co-host got into this line of work and so many of our guests. And it's so amazing to meet someone else and who's open about it and shares that, you know, that experience shaped you. And I hope that people can take that as an experience of strength and hope. You know, sometimes when there is darkness, light comes from the other side. And when you're in it, you don't know why. And it's hard to see, but just perseverance, keep going. There is something else there. And I think that's a beautiful reminder.
Ben:Yeah, and I think that's really well said. I was really lucky that, you know, I had cancer. I was really sick and lived in New York and had great care at Memorial Sloan Kettering. And then when my wife and I wanted to have kids, we were very lucky to go through IVF three times and were successful. But it was because of that, both understanding how grateful we were for getting incredible clinical care, but also dealing with the frustration of what's covered, what's not covered. You get a bill in the mail. Do I pay it? Do you pay it? Does the insurance company pay it? I don't know. And for the longest, I had no, no interest in starting a company it was never anything I wanted to do but just kept facing these same challenges and it was my wife that really said you know you should quit your job - I had a great job at Google, great life, great benefits and kind of was very lucky to meet two incredible co-founders. One was a long-term friend of mine actually my wife met in 2004 and and Jeff Whitten and Dan, our CTO, and we came together because we all felt really passionate that there was incredible clinical care or innovation, apps that help you do physical therapy online or mental health online, but there was nothing that really addressed the individual person in understanding what's covered, what's not covered. How much am I going to pay? Is this benefit covered? I'm getting a picking up a prescription from Duane Reade, am I paying more than I should? So we simply did something about it and which started as a very manual process. People would call us when we first started Sheer Health and we'd tell them. And then it evolved to building a really easy to use both app and website if people don't like downloading apps to help people before, during and after they go to the doctor, the dentist, the pharmacy, the optician. No one has time to call their insurance company. Nobody wants to wait on hold. Nobody ever likes that thing with the health insurance. So it really is... you know the mission of Sheeris for people to never have to deal with the health insurance again
Rena: Yeah i mean i'm such a huge fan and i use it personally i send all my patients there and it's it's really amazing i'm so happy to have a resource i always tell people just download share so tell actually tell our listeners anyone listening oh my gosh i have to get this how can they access it how do you become a user?
Ben: Absolutely you can go to sheerhealth.com s-h-e-e-r-h-e-a-l-t-h.com or if you have a android or a apple phone you can go to that app store and download it. Totally free. We have two different plans. One is totally free. Don't even need a credit card. And immediately once you connect, we'll do a claims review. So we actually look back at all of your past claims to see, did your insurance company accurately apply your benefits? Oftentimes they don't. So we'll flag and fix those issues for you. You may have overpaid on a bill. A claim may have been denied when it shouldn't. You may have paid more than you should for a prescription. And we can go back up to two years in the past based on your insurance plan and see, were there any issues that what happened and we'll fix those. And then moving forward, we can help in a number of ways. You can upload a bill and we'll tell you, is it correct to pay? And if it's not, we'll fix it. We can tell you anything about your benefits, obviously fertility and fertility. If somebody is pregnant, what benefits does the plan provide? Lactation consultants, breast pumps, anything like that. And then we handle all out of network claims to make sure people get the maximum reimbursement. And it really is simple and easy to use. We built it how we think health insurance should be, not how Aetna or United or Cigna have it today. So it's a really personal experience where you can also find a doctor. One of the big challenges we see is you go to your insurance website, you put in the acupuncturist in your zip code and you get back information that's not accurate. My wife actually wanted this, you know, a couple of years ago before we started Sheer. I looked it up. I got it for an acupuncturist. One person had passed away. One person lived in Wisconsin and the other person was, you know, was like a physical therapist for my hands. I'm like, but I asked for an acupuncturist. So it was just frustrating because I had to call all three. And so we've built just an app and a website that makes all of this easy. And it's really about allowing people to go to the doctor with confidence. And is this benefit covered? How much am I going to pay? Or if you get a bill, we'll give you, we do two things. We'll give you a heads up. We can say, Hey, Rena, for your March 7th visit to Mount Sinai, you're going to have a $200 bill. It's your in-network copay. So now when you get that bill, you know, yup, it's correct. I should pay it because we're big believers in if it bills correct to pay, you should pay it. We don't negotiate medical bills. If the bill's right, doctors should be paid the correct amount. Now, if the bill's wrong, we then will fix it. Maybe they sent it to your old insurance company, or they spelt your name wrong, or they got your incorrect member ID number. So we will fix bills that are not correct.
Rena: Amazing. Well, and I think the other point that you brought up is the the log of doctors or healthcare providers. How many people get so frustrated looking for a mental healthcare provider, acupuncturist, whatever, and yet the person doesn't take their insurance or they're not in town anymore, they're not practicing. And so the fact that you also have that functionality is amazing and such a needed service.
Ben: Yeah. And we do the same if people say, look, I don't care about insurance. I'm happy to pay out of pocket. I'd like to see the best occupational therapist for my child or a mental health provider that focuses on obsessive compulsive disorder we can also do that too because we have a lot of members we can see you know where are people going and that can then impact well if you know 5,000 people are going to this cardiologist that must mean this is a really great cardiologist based on clinical outcomes and based on you know procedures and whatever it might be so we also have the ability to help people really understand you know where should I be getting care you know we don't necessarily make recommendations like this is the best doctor, but we provide options and areas where typically it's very hard to understand, is this person in network or out of network, or I can't find any particular providers in this service area. So it really is, you know, Sheer Health is the go-to app to help you save time and money on health insurance and healthcare and medical bills or dental bills, and just getting the most out of it. If you're paying your premiums every month for a health insurance plan or a dental plan, you really should be able to maximize everything. You know, does my dental plan, have orthodontics for my kids, or I want to get Invisalign. Is there any benefit for that? We can help with all of that in real time.
Rena: What an amazing, amazing app. I'm so impressed with what you've created. Such a pleasure to know you. And, you know, I guess my gratitude is they're really continuing to connect with people in this space that really care, that just want to make healthcare better, both for patients and providers. You know, it's a really tricky space and it can be better, but I think it's you know, one of the things I love the most about this podcast and my work is meeting other people that are truly dedicated to this. So thank you so much for creating sheer health and thanks so much for coming on and sharing your wisdom and expertise and time. And I know that I think this episode is really going to give listeners a lot of hope that, okay, wow, it doesn't have to be this way. My life can be easier. And I think it's an amazing gift.
Ben: Absolutely. And thank you for this platform. I think for people to have a place to come and hear from, whether it's experts or people that are going through things like them, there aren't too many platforms like yours. So to be able to have this as a resource for everyone, where they can meet incredible experts, they can hear people with stories like them is phenomenal. So thank you for creating this platform and giving people voices and giving people hope that they're not alone and there are things or platforms or apps or people that can really help them. So I'm grateful for that.
Rena: Oh, thank you so much.
Dara: Thank you so much for listening today and always remember: practice gratitude, give a little love to someone else and yourself, and remember, you are not alone. Find us on Instagram @fertility_forward and if you're looking for more support, visit us at www.rmany.com and tune in next week for more Fertility Forward.