Approximately 56% of Americans seek mental health treatment annually, but most are uncertain about their insurance coverage. Behavioural healthcare providers face a significant administrative challenge in verifying insurance eligibility before commencing treatment, mainly due to the complexity of insurance plans that exclude behavioural health services and numerous special conditions.

Healthcare providers invest substantial time in manually verifying insurance coverage, resulting in frequent inaccuracies. Even current software tools struggle to achieve more than a 60% accuracy rate¹ when checking eligibility for behavioural health services.

These errors in insurance eligibility assessments result in claim denials amounting to a staggering $88 billion annually¹, causing additional costs and delays when providers resubmit claims.

Sohar Health (YC S23) is an insurance verification tool for behavioural health providers.

Speed - Reduce the time spent qualifying patients from 1-2 hours to seconds

Accuracy - Decrease the number of denied claims and reduce costs

Intake - Increase revenue as patients are more likely to start treatment due to automated insurance coverage checks

Founder

Dr Ashish Mandavia, Co-Founder & CEO - Previously EMEA commercial director at Quit Genius (W18) and senior manager at Simon-Kucher & Partners. I.BSc - Medicine with Management, Imperial College London

Lucas Gordon, Co-Founder & CTO - Previously CTO at Quit Genius (W18) and software engineer at WeSwap.com. MSc - Computer Science, Birkbeck (University of London)

Spotlight Analysis

Strengths

• Founder/market fit: co-founders have previously worked together and developed a strong network in the healthcare space

• Early traction: market demand is promising with $118k ARR in two months

• Strong tailwind: fast growth of behavioural health providers and regulation (2008 Mental Health Parity Act) encourage the use of software that improves efficiency and transparency

Weaknesses

• Integrations: health providers need seamless integrations across their EHR/billing tech stack to adopt new platforms

• Sales cycle: software sales in the healthcare industry traditionally suffer from long sales cycles

Market

Nirvana Health - Raised $7.5m seed extension round from Inspired Capital Partners in November 2021

Opkit - Raised $1m seed round from GFC, YC and others in March 2023

Key Details

Year founded: 2023

Summary: Sohar Health (YC S23) is an insurance eligibility tool for behavioural health providers.

Currently raising: Yes, raising $2m with $1.1m committed

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¹ From Sohar Health’s pitch deck