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Shruti:

Good afternoon everyone, and welcome to this webinar. I’m Shruti Mehrotra, Head of Marketing at Aarogram and host of the Efficient Care podcast.

We live in an era where all kinds of information are accessible at our fingertips, and we expect transparency in everything—from the food we eat to the products we buy. But when it comes to healthcare, a critical aspect of our lives, patients often face a huge information gap. They find themselves navigating a complex web of costs and procedures, and practices often don’t know what reimbursements they’re owed before they offer services.

Today, we’re here to shed light on this issue and understand the role AI can play in communicating better with patients.

Joining us today is Kashyap Purani, founder of Aarogram. He’ll be sharing insights on problems that hurt provider efficiency—especially around patient financial clearance—and how AI and automation can solve them.

Kashyap Purani:

Anyone who is a healthcare provider — after speaking with hundreds of healthcare providers, this story, I have seen it repeat so many times. It's about how a healthcare provider administrator runs their practice and what are the challenges they run into.

One of the biggest challenges they run into is the revenue loss due to eligibility checks and benefit verification. Any healthcare provider would have a patient walk in or call them up for an appointment. The first thing they do is capture their information and insurance, and they would have to check if insurance is active, verify the benefits for the services provided.

Most of the revenue loss occurs in this patient intake process when there are delays and errors in getting the right benefits or getting the prior authorization. Ultimately, all those things lead to claims denial, and that’s a very consistent error we have seen across many healthcare providers across many specialties.

The second thing we have consistently heard is the loss of appointment slots. You have appointments booked throughout the day for the next seven days or next 14 days for all your service providers. If you look at your schedule, it's jam-packed. But you get a call from a patient: “I would like to reschedule my appointment,” or “I don't know what the cost of the care would be,” or “I don't know how much insurance will cover,” or “How much, as a patient, I would be paying for this service.”

Let’s say the service is a sleep study or an MRI. When patients don't know about the cost of their appointment, they're highly likely to cancel those appointments. A lot of these lost appointment slots come very last minute. Providers don’t have enough time to schedule someone else. This is a problem we have heard repetitively.

Then you go next — a lot of patients are dissatisfied not because of the medical care or clinical care they have received from a provider, but mainly because of the lack of price transparency and the whole process of knowing the cost of their care from the administrative office of the provider. Often, if you see the reviews of this provider’s office, it will be more about the administrative team than the doctor’s team.

We have also seen a lot of profitability decrease due to the significant overhead on the staff for eligibility and benefit checks.

This is the story of Mike at Neurology Group — who has reduced revenue, reduced profitability, and much more overhead for his staff.

So — anyone — any questions? Do you run into the same problem, Kojo?

‍Kojo:

Yes—almost identical. I manage sleep studies and neurology, so we see the same issues Mike has.

Kashyap Purani:

Let me right away jump into it. A lot of things you can do pre-service — and you know price transparency matters, you've seen so far. What we have learned is that patient financial responsibility has grown from 5–10% to 30–40% of the total fees.

For example, if I was paying $100 for a sleep study, I would be paying $300 nowadays. Over the years, the cost for patients has increased, and we have seen a significant increase in claims denials due to errors in front-end processes — like missing prior authorization, reference codes, medical necessity notes, whether the insurance was active on the date of service, and many other issues.

Another aspect is that patients often don’t know the cost of care. There's a federal regulation called the No Surprises Act (2022). What does that mean? The No Surprises Act requires providers to publish their fee schedules so patients are aware. Not a lot of providers cater to this need in a patient-friendly way, but they do have to publish their fee schedules. Sometimes it's on their website, sometimes just over the phone. Often patients don’t even know that they are entitled to this answer.

If I go to the next point — this is how the current general flow looks like when you're not using a sophisticated AI solution:

• A patient inquiry or referral comes in, often via phone.
• Appointment gets scheduled.
• Between the scheduled date and the appointment date, you have to verify insurance.
• You make manual calls or log into insurance portals, check multiple portals, and record the benefits in a spreadsheet or EHR.
• Then, you manually calculate patient estimates or use some high-level estimator tool.

Generally, it takes 30 to 60 days for sleep labs because they only have so many beds and receive so many inquiries. Often, they're running behind on checking benefits. By the time the appointment comes, the benefits are outdated — deductibles might have changed or the insurance may have switched. Rarely, but it happens.

Patients may have also found someone else who is cheaper or waived the deductible, or who offers a better fee schedule. When the patient moves through the appointment, gets the diagnosis, and a claim is submitted — the day comes for payment collection. Claims could get denied. Now they have to repeat the whole process for claim negotiation. This back and forth causes much more revenue loss.

Based on our research, 83% of patients expect upfront estimates. You can imagine — when you don’t have a sophisticated process to deliver accurate estimates and verify the correct benefits for a specific service or CPT code — you're going to struggle. Your staff will struggle, and your patients will feel it.

Now, if you do have a sophisticated system — AI or automation — you can check the benefits as often as needed between the referral form and appointment date. It all happens automatically. You don’t need to log into a bunch of portals or wait on hold with the insurance company.

You can get all the information in real time at your fingertips. If the format is easy, and if you generate Explanation of Benefit (EOB)-style estimates that can be shared with your team and possibly with the patient, everyone is on the same page:

• “This is $100 cost of care.”
• “$90 will be paid by the insurance.”
• “$10 is the patient’s responsibility.”

Everyone speaks the same language.

The biggest challenge to achieving this is the need for end-to-end automation. If you're in Virginia or any metro area, you're likely serving at least 15 to 20 insurance companies at any time. It's very hard to train staff to know every single insurance, what CPT codes to use, what fee schedule applies, and what services are covered — especially if you have three doctors in your office.

Managing all this in spreadsheets becomes time-consuming.

With an AI solution, you can empower your staff. They’ll get alerts like:

• “Your patient has a high deductible — would you like to inform them?”
• “Here’s the patient’s estimated cost of care — this is the patient's responsibility.”
• “This patient has no deductible — would you like to schedule them sooner?”

Also, many insurances don’t even require prior authorization. If you have that information at your fingertips, you can schedule those appointments much sooner and fill your schedule faster.

When you have cancellations, periodic real-time checks help you refill those canceled appointment slots.

So how do we do all this? What does an AI or automated solution look like in today’s world?

Aarogram uses our SmartVerify Virtual Assistant, which combines our software platform, AI, and human assistants. We're experts at checking benefits, working with insurance companies, and serving providers in almost real time.

Kojo:

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We have kind of a hybrid — it's an older EMR system that we use to gather the information for our patients.
We also have staff that's supposed to be doing insurance authorizations, but part of the reason why I wanted to join this call is — it's fairly inefficient and not always accurate.

Kashyap Purani:

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Yes, and we have Prashant here — he mentioned he has just been calling the insurance companies and using different portals. It’s fairly manual and takes so much time.

Let me dive into the solution we have.
I'm going to show you a sample patient and walk you through what the quick, easy process looks like.

Patient Workflow with Aarogram

You can connect Aarogram with your EHR system. We’ll ingest all your patients into our system. Patients will appear in a specific “Not Started” status.

When you pick a patient and start processing them for a specific set of services — you can choose sleep study, MRI, consultation, CPAP, DME — anything configured for your organization.

You can also choose:

• The service provider
• The referral provider
• Member ID or insurance plan — fetched from your EHR or any other integration

If you don’t have an EHR, we also allow manual patient entry or a self-service form for staff or patients. The form captures:

• Patient information
• Date of birth
• Insurance info
• Service info
• Referral info

Click "Save" — that’s it.

SmartVerify in Action

Once the patient is in our system, you can run our SmartVerify system to fetch the latest benefits.

For this patient, I’ve already fetched the information — it takes 20 to 40 seconds.

You get:

• Insurance status: Active or not
• Effective dates
• Plan name & level
• Deductibles: Total & remaining
• Out-of-pocket max: Total & remaining
• In-network vs out-of-network benefits

If you're in-network with BCBS, you get one set of benefits; if out-of-network, another. Our integration fetches both types in real time.

Service-Level Benefits

We also show service-level benefits.
For example:

• Specialist consultation CPTs
• Home sleep test (95800)
• Remote patient monitoring

Let’s say deductible remaining is zero — that means the deductible doesn’t apply to that service.

You also get options related to out-of-pocket max:

• Plan-level benefit
• Administered medication (in-office or at home)
• Tier-specific benefit

If you're not sure, default to plan-level.

The more you use the product, the more our AI learns from your selections and applies them automatically.

Co-insurance for a home sleep test:

• Co-insurance option 1: 50% after deductible
• Option 2: 50% outpatient hospital
• Option 3: $0 (depending on plan)

You make a choice once; our AI will learn your behavior and apply it in the future. The more you use it, the fewer manual decisions you'll need to make.

Kojo:

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You mentioned AI — who else has access to the PHI? That’s a question I’ll be asked if I present this to a hospital.

Kashyap Purani:

‍Great question. We have a list of our data processors — we use AWS infrastructure and connect directly to payers like UnitedHealthcare and BCBS, as well as some brokers to ensure data accuracy.
We can share the full list for your audit.

Patient Estimate Summary Sheet

Once the benefits are finalized, you can:

• Choose your fee schedule: BCBS, Medicare Advantage, or industry benchmark
• Generate a summary sheet: A white-labeled EOB-style cost estimate for the patient

Example:

• New Patient Consultation (CPT 99203)
  • Insurance fee: $133
  • Coverage: $98
  • Patient responsibility: $35
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• Sleep Test
  • Contracted fee: $275
  • Covered by insurance: $275
  • Patient pays: $0

You can add as many services as needed — templates are customizable for internal or patient communication.

Kojo:

‍I like the transparency. Final question — if a patient requires authorization, does this help with that?

Kashyap Purani:

‍Yes, we have features for prior authorization support. I can show that in a longer demo.

Let me quickly wrap with this last point.

Aarogram’s Financial Clearance Co-Pilot

Our AI-powered co-pilot offers:

• Automated benefit checks
• Real-time cost estimates
• Website estimator widget (white-labeled)

Impact:

‍Staff of 5 → Reduced to 2 working on eligibility & authorizations
Workload reduced by 60–70%
Improved patient payments and revenue capture

Thank you, everyone. We've covered a lot. We’re here to help providers take back control and use AI responsibly to improve care and financial performance.

Let’s stay in touch — we’d love to follow up individually.

Thank you again for joining us!