Understanding US Healthcare Affordability: What Millions of Eligibility Checks Reveal About Patient Cost Exposure

For this piece, we’ve chosen to present the data on a state-by-state basis, showing the average across government and commercial plans within each state. This approach allows us to highlight national trends and patterns that we have observed.

Behind the Claims is a series celebrating the partners who power healthcare operations behind the scenes. Nirvana’s technology is built by billers, for billers—and we understand how essential it is to have systems that truly work for the people and organizations using them. Healthcare is ultimately powered by people.

Forget ghosts and ghouls. The real horror stories unfold every day in healthcare billing offices across America. Endless phone trees. Contradictory reps. Portals that promise automation but deliver chaos. What follows isn’t fiction. These are real accounts from online forums, retold as billing horror stories because, frankly, that’s what they are.

This month we launched Behind the Claims, continued our roll out of Annual Benefit Reset automation, were featured in the Out-of Pocket Healthcare Newsletter and welcomed Robert Andrews to our Advisory Council.

Behind the Claims is a series celebrating the partners who power healthcare operations behind the scenes. Nirvana’s technology is built by billers, for billers—and we understand how essential it is to have systems that truly work for the people and organizations using them. Healthcare is ultimately powered by people.

Radiology faces unique eligibility challenges: expensive procedures paired with complex prior authorization requirements that cause cascading delays and disrupt patient care continuity. Organizations investing in comprehensive eligibility solutions see significant improvements in patient satisfaction and operational efficiency

August was all about refinement. We focused on improving how we detect and retry on patient data, and how we can get your eligibility results even when member information is incomplete. Plus, we’re gearing up for annual plan resets–stay tuned for tools and updates in September!

Urgent care eligibility verification directly impacts cost transparency and patient trust. When patients seek urgent care services with conditions like broken bones or severe infections, they need immediate treatment - and they'll get it regardless of coverage status. What they deserve is immediate clarity on what that necessary care will cost them

Repost: The benefit reset period is a challenging time for providers nationwide, especially as antiquated systems have failed to scale with the volume and complexity of insurance plans. Nirvana’s API is a significant step forward for providers and patients, helping the busy end-of-year reset period pass with ease.