A few years ago, as Bethany Abbott stepped up to the counter to pay for her husband’s dental work, she was shocked to learn the practice would not take her medical insurance.
“I gave him our insurance card, and I was basically laughed out of the office,” she said. “The office manager at the dental office was like, ‘Oh, we don’t accept medical. We’re a dental office.’”
Any other patient might have shrugged the transaction off and pulled out a dental insurance card, but Abbott is not just another patient. Having spent decades in health insurance billing, where she helped build medical claims systems, she was more educated than most about the vagaries of reimbursement across all health care specialties.
“Dental insurance started back in the 1950s,” she said. “Back in the ‘50s, you could get a significant amount of care for $1,500. Well, they haven’t updated those rates more than just a little bit in 30 years. Somehow, big dental convinced doctors that they weren’t worthy of the reimbursement and pay that other doctors are.
“When my husband needed those services, I went back and made sure I was right before I argued. Sure enough, we got his whole reconstructive case completely paid for.”
Abbott felt vindicated, but more than that, she felt inspired and soon thereafter launched her own company, claimSTAT, which is changing the manner in which dental services are paid for. Specifically, the company makes it possible for people to use their medical insurance to pay for dental work, coverage that often reimburses at higher rates than dental policies.
The barrier that has confounded the industry for years is medical coding, the system that identifies covered procedures, upon which insurance reimbursement is based. The labyrinth of codes did not line up between medical and dental care, Abbott found, which made filing a claim akin to having access to a room with a safe in it but not having the right combination to open it.
Abbott developed an end-to-end system that fixes the coding gaps, thus allowing patients to tap into the dental benefits within the medical insurance policy they are paying for. Cracking that formula, Abbott recognized a mammoth business opportunity, even if it meant selling the dental industry on getting reimbursed through insurance in a whole new way.
“They just didn’t know. They’d never been taught,” she said. “An insurance company is not going to stand out there and wave a big shiny red flag and say, ‘This is how you get us to pay for things.’ Many people have tried to do this. Many companies nationwide have tried, but we’re the first to market with a full solution.”
Abbott started her career at Blue Cross and Blue Shield of Arkansas, through which she was able to graduate from college. Over the next three decades, she also gained experience from government work and aerospace.
“I ended up working for Blue Cross off and on through the years and then moved to different payers. I built many, many, many claims systems,” she said. “I was senior director of project management at Dassault Falcon. I built a fraud detection system for Medicare and Medicaid services out of Washington, D.C. I was director of implementation for Molina Healthcare right before I left to do claimSTAT.”
Based in Searcy, the company employs more than 20 remotely and handles more than $100 million in claims volume per month — not bad for a kid from Huttig, a speck on the Arkansas map that counted 450 souls as of the 2020 census, proving big ideas can take root anywhere.
“It’s just a little mill town. It’s in the middle of nowhere,” she said. “We didn’t even have a stop sign.”
As for her secret to revolutionizing an industry, she credited sheer perseverance for the bulk of her success.
“I stepped down from everything I was doing to launch claimSTAT. I haven’t looked back since,” she said. “I’m hardheaded. I knew this could work.”
Photo courtesy of BETHANY ABBOTT
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