Rick Hirsch is the founder of BillingNav, a company dedicated to protecting health plans and participants from unfair medical charges. With a background in reference-based pricing, Rick has worked to bring transparency and fairness to healthcare billing, advocating for patients and challenging unjust practices. His commitment to addressing the issues in the U.S. healthcare system continues to inspire his work at BillingNav.
What does BillingNav do, in plain language?
Rick Hirsch (BillingNav): We protect health plans and participants from having to pay predatory, invalid, and unreasonable charges for medical goods and services. Most importantly, we provide comprehensive advocacy and defense for plan members subject to abusive medical provider balance billing and collections efforts. BillingNav’s services include:
- Balance Bill Advocacy & Defense
- Credit Reporting Correction
- No Surprises Act Claim Negotiation & Arbitration
- Fee Estimate Requests & Overbilling Disputes
- Hospital Financial Assistance Eligibility Screening & Application Support
- Direct Contracting
What inspired you to start this company?
Rick Hirsch (BillingNav): I hate injustice and the abuse of power, and it angered me to see how hospitals and certain medical practitioners profit at the expense of people who do not have the ability to protect themselves from such abuse.
What are the best and worst things about your job?
Rick Hirsch (BillingNav): The best thing about my job is solving problems for people who need and deserve help. The worst thing is continually being confronted with a U.S. healthcare procurement and financing system that is mischaracterized as being “broken” but that in reality is dysfunctional, discriminatory, and unjust by design.
What misconceptions about hospital billing or reference-based pricing would you like to clear up?
Rick Hirsch (BillingNav): There are a number of them:
- The false belief that reimbursement at Medicare plus 20% or 30% always yields a fair reasonable result.
- The false assertions that balance billing only occurs for 1-2% of claims and is not a major problem for RBP plans.
- The notion that payors cannot meaningfully influence the outcomes of IDR arbitrations of NSA claims.
Who else in healthcare inspires you, and why?
Rick Hirsch (BillingNav): This is unavoidably going to seem like pandering, but you inspire me. Marshall Allen inspired me, as do investigative journalists such as Brian Rosenthal and Sarah Kliff, who report on unreasonable healthcare billing practices.Bill Rusteberg was a big inspiration for me when I first started working in the RBP space.
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