Understanding and using health insurance shouldn’t feel like solving a puzzle. Yet for many patients, figuring out what’s covered, who’s in-network, and how to get care involves confusing paperwork, long hold times, and too many dead ends.
HealthCheck is changing that by giving patients, providers, and payers a shared digital infrastructure that simplifies the entire experience—and drives value for everyone involved.
Empowering Patients with Clarity
HealthCheck’s AI agents guide patients through every aspect of their coverage, using plain language and real-time data to:
Explain benefit eligibility and plan rules
Identify covered services and cost-sharing requirements
Surface in-network providers based on specialty, location, and availability
Recommend preventive care services based on coverage and history
This helps patients make informed decisions—and avoid costly surprises.
Automating Prior Authorization
One of the biggest sources of delay and frustration in care delivery is prior authorization. HealthCheck automates this process by:
Submitting digital prior auth requests with structured clinical data
Matching service codes to payer policies in real time
Providing instant feedback on coverage status or needed documentation
By handling the back-and-forth digitally, patients wait less and providers spend more time on care.
Navigating Formularies and Med Access
Patients often get stuck at the pharmacy counter due to formulary restrictions or prior authorization on medications. HealthCheck solves this with:
AI agents that check formulary status instantly
Suggestions for preferred alternatives when coverage is limited
Automated generation of prior auth or step therapy appeals
The result? Fewer denials, better adherence, and happier patients.
Helping with Claim Denials and Appeals
When a claim is denied, HealthCheck empowers patients and care teams to:
Understand the denial reason using plain-language explanations
Resubmit or appeal with automated documentation support
Track resolution status and escalate if needed
This ensures that administrative friction doesn’t delay necessary care—or billing.
Delivering Value for All Stakeholders
For patients, this means peace of mind, better outcomes, and lower out-of-pocket costs.
For payers, it means more efficient operations, better member satisfaction, and improved STAR/HEDIS performance.
For providers, it means fewer billing issues, faster care delivery, and stronger patient relationships.
Connected, Compliant, Coordinated
HealthCheck integrates with:
Payer APIs
Provider directories (NPPES, PECOS)
Formularies
EHR systems
To ensure that data flows securely across the ecosystem. Every step is logged, auditable, and HIPAA-compliant.
With HealthCheck, navigating coverage isn’t a burden—it’s a built-in benefit.
For patients, providers, and payers alike, it’s the smarter way to manage healthcare.