Meet the Founders: SuperBill’s Journey from Mental Health to FinTech Company
February 23, 2023
If you don’t already know, SuperBill is a company revolutionizing the way patients get reimbursed for their medical costs. SuperBill just released an exciting new FinTech product called SuperPay that integrates bill payments and claims filing into one headache-free process. On the eve of this milestone, I sat down with SuperBill’s co-founders, Sam Schwager and Harrison Caruthers, to look back on how they got here.
As a newer company navigating a complex health insurance space, SuperBill has had to be nimble. Sam and Harrison talked about how adaptability—and a lot of time spent listening—helped them find their way. They walked me through the full evolution of SuperBill, from the early days of cold-calling healthcare providers, all the way up to the present launch of SuperPay.
The co-founders had a lot to say about the balance between simplicity and big ideas. They also stressed the importance of maintaining both flexibility and intellectual honesty. If you have any interest in healthcare, tech, entrepreneurship, or financial services, you’ll probably find something for you in their story. And if you already use SuperBill to handle your out-of-network claims-filing, come on in and meet the technology’s creators!
The Issue That Launched a Company: The Care Gets Left Behind
Sam Schwager was working as a consultant in the early days of the pandemic. Like many of us, the pandemic nudged him toward more proactive mental health care. And like many of us, he saw how expensive therapy can be.
But it was the reimbursement system that really got on his nerves. He was determined to get the money his insurance plan promised him for out-of-network services, but the reimbursements never seemed to work out cleanly. Schwager filed one out-of-network insurance claim after another, only to see them delayed, short-changed, or outright denied by his insurer.
He spent a lot of energy simply trying to use his out-of-network (OON) benefits and got little in return. Fortunately, he gained knowledge of the insurance industry’s shortcomings. In the long run, that knowledge would prove useful; but for now, Schwager felt the same way most people do when trying to get their care reimbursed: frustrated. When I asked him what aspect of the reimbursement system frustrated him the most, he said it’s that, “The care gets left behind.”
In the constant back and forth between providers and insurers, a certain quality to the care is lost. This is never more apparent than in out-of-network care, where therapists and other specialists not only create but also often file superbills for their patients. This work is rarely recognized, much less compensated. And it eats up providers’ time and attention, and ultimately, less energy available for their patients.
Getting Down to Business
Schwager, an experienced software engineer, looked for a way to simplify things. He called his friend and former Stanford classmate Harrison Caruthers and told him he wanted to start a company. His idea, he told Caruthers, was a chatbot for mental health check-ins.
The pandemic had forced therapy to go remote, and therapists were struggling to keep tabs on all their patients. Schwager figured automating a bit of their work could help, so he wrote some software in his spare time. It was programmed to send simple queries and reminders a therapist might offer their patients. How are you feeling today? Have you tried journaling about this feeling? Have you talked with anyone about this? Etc.
“I wasn’t really on board with his first idea,” Caruthers confessed. “But it made me think.” The pandemic had Caruthers ready to commit to therapy himself, and like many people following the news, he was aware of the strain on mental health specialists. He saw the same need as Schwager: something could be simplified. They just weren’t yet sure which thing. They shelved the chatbot and explored other ways to assist with mental healthcare, and before long, they teamed up and committed themselves full time to improving remote therapy.
The nature of this first call is characteristic of the co-founders’ relationship. Schwager dreams big, tossing ideas at the wall, and Caruthers lets him know what sticks. Caruthers has a steady, easy-going demeanor, but he’s sharp and will tell you the truth.
“Harrison keeps me grounded,” Schwager told me. “At least, that’s often how it goes. But we switch roles all the time.” Schwager is upbeat, positive, and creative, always ready to try a new angle to get around an obstacle.
Caruthers agreed. “Sometimes it’s Sam reigning me in. We both have to keep each other honest.” Watching them work, this seems like a key to their success. Schwager and Caruthers have a deep understanding of each other’s tendencies as thinkers, programmers, and leaders. Their relationship began in their freshman Computer Science course at Stanford. They spent the next four years collaborating on software projects, participating in startup bootcamps, and hanging out.
“We were friends first,” said Caruthers. “The startup stuff came later.”
Haven Health and the Genesis of SuperBill
At one of those startup bootcamps, the co-founders’ ideas took shape. The result was Haven Health, a digital platform they built to enhance remote group therapy sessions. Haven took cues from the remote learning innovations shaping universities during the pandemic. It gave mental health providers the freedom to customize their group therapy sessions. On Haven Health’s virtual portal, providers could create assignments, ask questions, share resources, and more.
Schwager explained that a major challenge for any provider during quarantine—in healthcare, education, or elsewhere—was competing for leisure time. People were skipping their group therapy sessions to watch Tiger King or play Animal Crossing. Schwager and Caruthers built Haven to make remote group therapy more dynamic, so patients would want to engage with their therapy groups.
Providers loved it. They were just as tired of Zoom as their patients were, so they enjoyed using a new digital space that was creative and adaptable. Unfortunately, the platform wasn’t economically viable. Schwager and Caruthers had gained a sizable list of interested therapists and a working knowledge of the mental healthcare system, but they needed a new direction.
“We knew how to work with therapists, and they appreciated what we were doing,” said Caruthers, “but we had to find a market, too.”
I was curious why the duo felt so sure they had to work in the healthcare space. Schwager rattled off the numbers. “Total health care spending grows 5.5% each year. Total out-of-pocket patient spending grows by 10% each year. By 2026, patients’ total out-of-pocket spending will reach $800 billion. 1 in 2 Americans already carries medical debt. It’s the leading cause of bankruptcy.”
Schwager spoke so quickly I felt a bit dizzy. You can review Kalorama Information for the data on out-of-pocket spending and CMS for the total spending data, but neither Schwager nor Caruthers has to check the stats anymore.
“Pitching the business to investors has burned those figures into our brains,” said Caruthers.
Living with those numbers in their heads for so long now, they’ve lost some of their shock value to the co-founders. But to me, the numbers are staggering. It seems we have, in the United States, a healthcare system that transforms physical and mental ailments into financial ones. Meaning, the ailments aren’t really cured. Instead, the pain is transferred—from your body to your bank account.
You can address this issue from a number of angles. Caruthers and Schwager chose insurance reimbursements. By helping patients get better reimbursements for their out-of-pocket spending, they could reduce the financial harm done to regular people. And possibly even slow the growth of medical debt.
Therapy accounts for a big portion of out-of-pocket spending, and Caruthers and Schwager knew a lot of therapists. It was a natural place to start. They picked up the phones and called all the therapists they knew, and some they didn’t know, offering to file their patients’ insurance claims.
It wasn’t easy. They had to file the claims manually, a task that most Americans hate. But through trial and error, and by listening to providers’ feedback, they learned how the process worked, in the hopes of one day automating it.
“The insurance reimbursement system is so complicated,” Caruthers told me. “It took 4 or 5 months of constant work just to wrap our heads around it. And a year later, we’re still learning new things every day.”
“There were certain aspects of the system that seemed intuitive, like courtesy billing,” added Schwager, referring to providers filing out-of-network insurance claims on their patient’s behalf. “Of course it’s a helpful thing a therapist can do for their patient. But we had to talk to actual therapists to realize how taxing it was. They’re already overbooked with sessions, and now they have to file the paperwork on top of it? We wouldn’t have noticed this if we weren’t constantly asking providers their opinions.”
I call this humility, but Caruthers insisted it had more to do with intellectual honesty. “We’ve had to be honest about what we don’t know. It’s the only way to get better,” he said.
In fact, the phrase “intellectual honesty” came up more than once in our conversation. It seems to be what kept SuperBill nimble in its early days. There’s a prevailing notion in startup culture that the best aims for a new company are speed and disruption. Mark Zuckerberg’s famous motto comes to mind: “Move fast and break things.”
Yet this was not the attitude for Caruthers and Schwager. “We do try to move quickly,” said Schwager. “It’s sort of necessary to secure funding. But you still have to care, and that takes time. If we had walked into an industry like health insurance and said ‘Hey we know how to optimize this! Listen to us!’ we would never have gotten off the ground.”
Their measured approach started to gain ground. They wrote software that automated a significant portion of the mental health claims-filing process. And along the way, they had become pretty well-versed in insurance reimbursements. But they were just getting started. Learning about superbills and therapy reimbursements, they realized that their work could apply to all kinds of out-of-network reimbursements, not just therapy. It was time to grow the business.
SuperBill’s Growth and the Invention of SuperPay
Schwager and Caruthers incorporated their company as Haven Health, Inc. in June of 2021 and pivoted to SuperBill at the end of 2021. They named SuperBill after the superbill documents they were using to file patients’ claims. For more information about how they work, read our post, What is a Superbill?)
They continued to learn on the go, filing claims and forming trusted relationships with providers. I asked them to share the most important thing they learned founding Haven Health.
“Keep it simple,” said Schwager. “A business needs a clear and simple value proposition. At Haven, we were trying to do too many different things at once. That made for a hard pitch. With SuperBill, we narrowed our focus.”
SuperBill saves you time and money on out-of-network reimbursements. Full stop. Even though providers liked Haven’s broad functionality, simplicity and ease of use were more important, the co-founders told me. So I asked them what people like most about SuperBill.
“The time it saves them,” said Schwager. “It seems to be even bigger than the money. A lot of families use SuperBill. Busy parents don’t have the time to file all their kids’ claims.”
So, therapists who are busier than ever due to a global pandemic, and parents who historically have never had enough time in a day… there does seem to be a common thread. At the beginning of 2022, Schwager and Caruthers switched into fundraising mode to pitch this value-add to investors. And by the summer, they had secured seed funding.
With that, they built a new website and hired a few marketers and software engineers. By November of 2022, SuperBill was a team of 12, and the company was receiving positive reviews from both providers and patients. But Caruthers and Schwager wouldn’t stop there. They saw an opportunity to simplify things even further. Enter SuperPay, a new solution for out-of-network insurance billing.
With SuperPay, getting reimbursed for out-of-network care is as simple as paying your provider. Providers collect payment via their patient’s SuperPay account, and SuperBill automatically files an insurance claim on the patient’s behalf, for free. The patient’s care costs the same, and providers get paid their full rate up front. The cost of the service is covered by the ~3% processing fee providers pay when charging a credit card.
“We think it makes things a lot easier,” Caruthers said. “For patients and providers. Patients don’t have to lift a finger to get reimbursed. They’ll never have to wait on the phone with their insurer again. Providers like it because they don’t have to pick up the slack when patients forget to file their own claims. And they get the peace of mind that they’re being paid reliably.”
Schwager explained SuperPay further: “People have given us positive feedback about SuperBill’s reminder features, like showing your progress toward your deductible, or the out-of-network benefits calculator. But they still have to spend their time using these things. The way to save people even more time was to eliminate the need for reminders altogether.”
When your claims are filed automatically, you don’t even need to be reminded about them. Of course, you can still track your claims, check your deductible progress, or calculate your benefits for free if you’re using SuperPay. But with SuperPay streamlining the patient experience, you have the option to leave all those reimbursement tasks behind and forget about them. Which, to me, sounds really nice.
SuperPay launched in December 2022 and has rapidly grown in popularity with providers. We’re excited to see where it goes. If SuperBill’s history is any indication, it could open up entirely new avenues for the company, and for anyone frustrated with out-of-network reimbursements.