In this episode of Understanding Healthcare, Stedi founder Zack Kanter sits down with Eliana Berger, co-founder and CEO of Joyful Health, to unpack one of healthcare's most persistent and least visible problems: the billions of dollars in earned revenue that never reach providers.
Eliana grew up watching her family run a therapy practice, where nights and weekends were consumed by insurance claims. That experience sent her on a year-long deep dive into clinics of all sizes and specialties, where she discovered the same anxiety everywhere: practices never quite knew when they'd get paid, by whom, or why certain claims had gone silent. What looked like a staffing or workflow problem, she realized, was actually a data infrastructure problem.
A single patient claim moves through electronic health records, billing platforms, clearinghouses, payer portals, and bank accounts before payment arrives. Context erodes at each handoff. No existing system connects them. The result is that providers can see revenue is missing but can't pinpoint where or why — and teams spend enormous effort playing financial detective across eight browser tabs just to work a single denial.
Topics in this episode
- Why healthcare revenue data is so fragmented across systems
- The difference between rejections, denials, and stale claims
- When to appeal versus simply resubmit a corrected claim
- How payers use vague denial codes that function as red herrings
- Why batch reprocessing often outperforms one-at-a-time appeals
- How Joyful's AI handles research while expert billers handle judgment
- What a 95% recovery rate actually means — and how it's measured
- The contingency vs. partnership pricing models Joyful offers
- Contractual underpayments: the next frontier after denials
- One change that would meaningfully improve the whole system
