best of luck to them. very hard area due to regulation and compliance issues. you better like being audited.

i just wonder if it's clear to them that this likely will be a national company? scaling this past the US will be very, very hard - this is using patient data, which is highly protected and in a lot of cases is not allowed to be hosted outside national boundaries.

this is my first litmus test for enterprise start-ups btw - does this work outside the US? the US market is big, but a lot of enterprise customers are multi-national and do not purchase completely local solutions.

Every insurer like this, however, is US focused, and a lot are per-state. The only corner cases are US citizens overseas and visitors in the US.

Also, to a first approximation, the world healthcare market for private insurance is the US.

I don't get what you're saying?

There is a large private insurance market outside the US. A lot of private insurance is augmenting state-run schemes, just look at Germany - the Krankenkassen system is not that different (lots of players, government mandated, plus private additions if you like shorter wait times or private hospital rooms).

What I was trying to say that if you're limting yourself to a single market like the US, the growth potential is not that big, same for your target market size and ultimately the amount of money you can make. as an investor something like Workday has more "fantasy" in terms of potential growth than something that caters to a very limited, national audience.

The company I work for launched a similarly national product and killed it after 6 months. Would have worked in the US, but then what? Our other stuff is truly global, so now that we cover the US fairly well we still have a lot of growth in OUS markets.

The number of people outside the US is big, but the financial value of secondary-to-national-insurance medical care is tiny, and the rules are really simple and transparent (often, it's a single vertically integrated secondary provider -- like BUPA in the UK -- billing for vertically integrated health providers like Kaiser in the US is also fairly simple). I only know the US and UK rules in detail, but the UK is actually simpler than even most US single-payer systems (e.g. DOD TriCare duty) in terms of recordkeeping. (this is largely a good thing for non-US countries!)

I'd be pretty comfortable building a health insurance eligibility service which only covered California. Covering the entire US market is well over 50% of the value in that market.

The unknown are places like China and Africa which have much more limited health care markets today, but which are rapidly evolving. It's reasonable to think they might adopt other systems than what they're using now (largely government-direct or charity or cash private doctors). Maybe the big US companies will be successful in promoting a damaging product (US-style health insurance) to other countries, like we did with cigarettes, but I sincerely hope not.

Stripe, on the other hand, absolutely must expand into other countries, or else the "Stripe of Europe" or "Stripe of China" might someday be able to challenge Stripe.com over who is the "Stripe of the USA". And Stripe is still tiny compared to the market even just in the US.

This is indeed a hard problem to solve. Glad to see someone attempting it. I think partnering with one of the major insurance providers should help kick-off the product at great scale and learn a lot.

All the best!

I think this works fine for basic eligibility checks where it's just a matter of is it covered or not. But the real pain (and where hundreds of millions if not billions of dollars are spent) is in radiology. There is a lot of friction put into place (think RBM's) to make it difficult to order any imaging.