Simplee keeps tabs on US health-care expenses

Website allows user to organize health-insurance bills, notifies customers of unnecessary charges made by companies.

Hospital beds 311 (photo credit: Ariel Jerozolimski)
Hospital beds 311
(photo credit: Ariel Jerozolimski)
A few years ago, Tomer Shoval went for a vacation with his family to Mexico. What began as a holiday soon turned into a nightmare, as one after another of the family members got sick and needed medical assistance. When he returned to the United States, he thought that the problems had been resolved.
But over the following weeks, a series of letters and monetary claims began arriving – from the doctors who treated them and insurance companies – that almost dwarfed the nightmare in Mexico and exposed him to the bureaucratic chaos that is the US health-care system.
Shoval did not understand what he had already paid for, what he hadn’t yet paid for, and why he needs to pay at all.
Shoval, who used to be the director of business operations at in the US, along with his old friend Roberto Rabinovich, who at the time was product manager at the giant Internet company, together with a third friend, Tom Tsarfati, decided to found Simplee, which as its name says, aims to simplify the way a patient interacts with doctors and insurance companies.

For those who don’t know it, the US health-care system is completely different from Israel’s. Whereas everyone in Israel is covered by one health fund or another, in the US there are no health funds – everything is based on private insurance companies. A patient who goes to a doctor for a consultation or for treatment does not pay at that time. The doctor sends the bill to the patient and to the insurance company the patient is covered by, which then checks the bill and, according to the policy, decides how much it will cover and how much the patient needs to pay.
The insurance company then sends the letter to the patient. This chain of letters continues for weeks or even months after the first doctor’s visit. Each patient has separate insurance policies for different treatments (for example, teeth and eyes); as a result, most Americans have a hard time making sense out of all this bureaucratic mess.
“These letters look like the letters sent by insurance companies in Israel – lots of unclear numbers,” says Rabinovich, Simplee’s vice president of operations. “The average American takes these letters and stuffs them under the rest of their mail. All of this causes Americans tremendous frustration, and our product is intended to create a different experience for these same insured patients.”
Simplee offers one website, to which the user can attach all of his heath-insurance bills and then organize them. The interface and the design are simple. The site also translates the complicated insurance language into more understandable terms, as well as sending warning notices.
Rabinovich says Simplee works with 12 of the largest health-insurance companies in the US, and it deals with more than 200,000 different doctor visits. Although the product is tailored to the US market because of the complexity of the US health-care system, it still has great potential, as 66 percent of Americans have health insurance, he says.
One of the most interesting features of the Simplee product is the notification of unnecessary charges made by insurance companies.
“Some Americans don’t know that if they visit a doctor who does not have an agreement with their insurance company, they pay more,” Rabinovich says. “So the system warns them that if they go to this doctor again, they will pay heavily, since he is not in their arrangement.”

In addition, the system checks if debiting mistakes were made by the insurance companies, he says, adding, “We were able to save one of our customers $1,400.”
Simplee operates an R&D center in Israel and is currently hiring developers and programmers. Business development takes place in Palo Alto, California, where Shoval resides.
The site is free, and its cofounders want it to remain that way. They are looking to cooperate with a few entities:
• The collection agencies that charge the customers and the insurance agencies (the Simplee product should streamline the collection of payments).
• Companies and large organizations that want to provide their insured employees with a friendly interface.
• Use of their database to help people find coverage that is more appropriate for their health situation and for referrals to private insurance companies.