PatientPay and ClearGage merge: Interview with CEO Tom Furr

PatientPay and ClearGage are merging. I interviewed CEO Tom Furr to get his take. The combined offering is intended to deliver a comprehensive billing and payment platform that includes estimation and eligibility along with streamlined patient payments.

Doctors offices are generally set up to bill insurance, but patients are now responsible for a lot more of the bill. Offices that manage patient payments effectively perform much better financially and reduce friction. That's what PatientPay enables.

Patients (i.e., consumers) have become accustomed to smooth transactions through Amazon and other e-commerce and in-person experiences. So physician offices can appear archaic in comparison unless they're using something like PatientPay.

Tom was a guest on the show several years ago, and it was great to have him back to share the big progress his company has made. 

As of March 2025 HealthBiz is part of CareTalk. Healthcare. Unfiltered and can be found at the following links: 

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Host David E. Williams is president of healthcare strategy consulting firm Health Business Group. 

Episodes through March 2025 were produced by Dafna Williams.

Transcript

0:00:04 - David Williams
Healthcare providers are collecting a lower and lower percentage of what patients owe them, and now collect less than half of what they're owed, according to some analysts. Enter PatientPay, which helps providers solve the problem without alienating their patients. Hi everyone, I'm David Williams, president of strategy consulting firm Health Business Group and host of the Health Biz Podcast, where I interview top healthcare leaders about their lives and careers. My guest today is Tom Furr, founder and CEO of PatientPay, a billing and payment technology company that just announced a merger with ClearGage, a healthcare estimate and payment solutions company. If you like the show, please subscribe and leave a review. Tom, welcome to the Health Biz Podcast. 

0:00:56 - Tom Furr
Thanks for having me back, David. I hope all's well. 

0:00:59 - David Williams
I was going to say not just welcome, but welcome back, because it's been since 2013. So you know, I don't know if we'll be on in another 11 years, but it's been good. I've been keeping an eye on patient pain, You've been continuing to do the right thing and the problems remain, although you're chipping away at them. 

0:01:16 - Tom Furr
Well, they not only remain but they grow every day and, as you alluded to, there's more people with high deductible plans, so thus there's more out-of-pocket dollars and health care has never been really strong at collecting those patient balances. They've done really well at collecting insurance balances, but patient was kind of a second nature, smaller part of the pie, and now it's a bigger piece of the pie. It's become a material part of their financial collections. So folks like PatientPay continue to work with those that want to do better with their patient collections. 

0:01:55 - David Williams
Sounds good. Well, let's wind back the clock and I want to talk about your childhood, tom, if you don't mind. And I mean before 2013, because you weren't a grown person even then. But what was your childhood like? Any influences that have stuck with you from that time? 

0:02:10 - Tom Furr
I've got parents that were entrepreneurs and so growing up I was cutting grass, painting houses, anything to make money at when I wasn't at school or playing sports, but it was fun. When I was in college I actually sold T-shirts, which was kind of my little side gig that I was doing to make money. And after I got out of college I got into the payments business and it was spending some time in the payments business where you realize that software is the power behind payments. And after I had kind of come to the point where I was ready to move on from my last company, I was, quite frankly, having a bottle of wine with a good friend of mine in health care, and you mentioned patient payments. 

Yeah, at the time, as you know, many, many years ago, you didn't pay anything out of pocket, it just was all included in insurance. And he's explaining how it goes from A to B to C. And then you know insurance companies are negotiating costs with the doctor. They're then having to adjudicate based on the patient's insurance plan and only at that point even know what you owe. Much less can you go out and collect it. So it seemed like a big challenge that was going to be fun to tackle. And here we are many, many years later and four patents issued and all kinds of good stuff going on. So it's a long and winding road, as the Beatles used to say. 

0:03:40 - David Williams
Well, I always used to have good health insurance when I used to work at big consulting firms like Boston Consulting Group, and I remember they had a $5 copay. And you're thinking, what is that? It's like a nuisance, right, and I think it was barely factored into the economics. But, as you say, things started to change and when you were looking at this back around I think 2008 was when you got started Were you already seeing some of these larger balances? Wasn't just these $5 that were you know could go one way or the other? 

0:04:12 - Tom Furr
Yeah, a friend of mine started the business and I was kind of an investor and advising him in 08, 09. And there was a report by McKinsey that came out and talked about how patient balancers are going to grow and there wasn't really good infrastructure to support that as there is in the insurance world and it was probably 2010 or 2011,. I finally got involved with the company full time and it's been an interesting ride because, to your point, when we first got into this, doctors say well, I just write off patient payments. Right, $5 is not a big deal, not material. I'm thinking to myself, why do you write off anything? But it was not coming out of health care. It now makes more sense, having spent a lot of time in health care. 

When the Affordable Care Act passed, that really started to shift people away from those nice insurance plans like you had and many others, to more high deductible plans so that people take responsibility for their health care spend and it's like going into a restaurant and you don't have to pay for anything. Or maybe you have a $5 deductible. You might want a nice big bottle of wine and a big steak or a big piece of fish and maybe a dessert. You don't really care, it's just you know it's $5. And so to control you know the cost the Affordable Care Act pushed some of that onus on the patients so that they would be a little bit more responsible. 

Now high deductible plans are becoming, I think, 50, 60 percent of the market, or on its way to 50 percent of the market, and it's not only forcing patients like you and me to say, well, how much does this cost? But it's also forcing medical groups to say wait a minute, this is 20, 30% of my revenue. This is a material part of my cashflow. How do I get better at not only offering a good service when it comes to clinical. How do I send the bill out? 

That is easy to understand? How do I append that, if possible, to the EOB? How do I allow it to be paid like with a mobile device versus, you know, a check? How do I do all these kind of things that everyone outside of healthcare have been doing and people are comfortable with? And so we came out of the payment space. We thought healthcare would be moving a little bit quicker towards the things that we're doing today, but right now we're finding a lot of folks realizing this needs to be addressed, and when it's addressed properly, patients don't mind paying. If they understand the bill, they understand they owe it and it's an easy way to pay it. 

0:07:02 - David Williams
Yeah, I was going to say, tom, you know, the thing is, when I, you know you think about someone, has the people, like their doctor, to kind of more or less understand their insurance, and so you know why don't they pay their bills, why doesn't the patient pay their bill? I pay my electric bill, you know. I pay my other bills, but somehow when it comes to health care it's like maybe I won't pay it. 

0:07:21 - Tom Furr
Well, there's a study that was done. Healthcare bills are like the last ones to pay and it's partially because in the olden days they didn't think the doctors needed it. They were making enough money, which now is not the case anymore. But it's also very confusing, and in my family if my wife or my kids have healthcare bills, I pay them. I'm in the business and I still get confused with these healthcare bills Because the question is one why did I get it? 

So now I've got to look at my EOB to make sure that it has been adjudicated. I do owe it because it hit my deductible. And then how do I pay it easily? Because when I get a paper statement it goes into the drawer. As soon as it gets kind of high, I pull it out and say, oh gosh, I think I owe this bill and log in. And they have these portals that make it very challenging to even get into much less. Pay a bill. You can pay, a dollar, you can pay. You know these one-off things and and it's uh, it's pretty challenging so to have the ability to one make a bill easy to understand. In certain instances we're able to pull the eob together with the bill, um, so that they can see their eob, they can see their bill and, of course, kind of like you know they. 

0:08:47 - David Williams
They say like eob. The main thing people know about that so-called explanation of benefits is it is not a bill, that's's right? 

0:08:54 - Tom Furr
Well, it's not a bill, so what the heck is it? I'm not kidding. 

0:08:57 - David Williams
So what you're saying? You give them the, not a bill with the bill, and then you got the whole thing. That's right. 

0:09:03 - Tom Furr
Yes, yes, that's right, this is not your bill, this is a bill from your insurance company. Yeah, so we do that. We also make it very easy to pay. I mean, that's another key component, and we look at things like an Amazon does. 

Right, you find something you like. It's very easy for you or your children or your wife or your significant other to pay. It's will get your card on file so that you put it in your digital wallet, your patient pay digital wallet. We will also allow you to use that for any doctor that joins the patient pay network so that we're able to pull back to you as a central person all of your bills, assuming that your doctors are using patient pay. So, one, you can see them all. Two, you can better understand them. And three, you can pay them with the same credit card or multiple credit cards. Some people have an HSA account. It might or might not have dollars on it and then it drops to your regular credit card. So, to make it as easy as possible, as we like to say, the Amazon effect, we think is a key part of the whole understanding the bill and the other challenges within healthcare. 

0:10:18 - David Williams
That makes sense, just thinking from my own experience. So I'll get a bill. Let's say I want to pay it, but a lot of doctor's offices are open like nine to four, with at least a half hour for lunch, and most of my time I'm looking at a bill is not during those times. So then you're going to call and what am I going to? Leave my credit card on their answer machine. So that's one issue. Another issue and, I think, something that's different. 

Another thing that's really pretty different about healthcare is when I see a bill, I'm not sure I really owe it, like for Amazon. Like for Amazon with your example, like if I'm going to buy myself, you know, a new shirt or a hat or a book, like I expect to pay it, you know, not just the copay, I'm going to buy it, that's the price, I'm going to get it. But when I go to the doctor's office I may be confused about what I'm going to pay. And they send me a bill. Maybe I don it last month, or maybe they sent me a bill was from something that's three months ago, I don't even remember. Or maybe I'm sick, which is why I got the bill in the first place. So it seems like there are a lot of complexities there beyond the typical Amazon experience. 

0:11:24 - Tom Furr
David, you're spot on. So it is very challenging. As I mentioned, you don't even know what you owe. Normally, you might have an idea of what you might owe, but you can't, like Amazon, say, okay, I'm buying a shirt for $50 or whatever the cost is. So to try and simplify that as much as you can within a system that is very complex is the opportunity for folks like PatientPay and others, so one we make sure that the bill is very detailed. You went to see this doctor on this date. To your very point. You might have had multiple events, but you went on this date, you saw this doctor. Here's what you had done. So you can simplify. 

Instead of the CPT codes, which, as you know, are very complex explanations, if you can get the EOB, you bundle it together so that you now say, okay, my insurance company is saying they've adjudicated it, I owe it, this easy to understand bill is over here and I can understand it. And then you give them an easy way to pay. Because right now, like I said, normally what happens if you had multiple doctors? You go into multiple portals, you might have to have multiple logins, you have to have multiple credit cards, multiple experiences. 

It's the most disconnected, very challenging industry to pay in versus hey, this is it, it's on my phone, I understand it. Yep, I'm willing to pay it. Let me go ahead and push the button to pay now. Yep, I'm willing to pay it. Let me go ahead and push the button to pay now. And that's kind of how we've approached this and, quite frankly, 71% of the people that pay their bills on patient-paced platform do it through the mobile phone. So, to simplify a very complex bill, make it easy to understand and easy to pay is really a key differentiator for patient pay versus a number of other more traditional solutions that are out there, primarily the paper-based ones. 

0:13:25 - David Williams
Got it. So you mentioned that the problem is rising. One of the reasons the problem is rising is just the cost of health care has gone up and probably since we spoke in 2013, it's probably doubled you know, doubled, maybe more, who knows At least, but it's you know, it's multiple. I remember when it was $2 trillion. Now it's $4 or $5 or $6 trillion, I don't know. It's pretty big, and part of the issue is that with a high deductible plan, although the patient has responsibility, they're thinking twice before ordering that steak or whatever. 

Sometimes the bills are just kind of high and so one reason somebody might not pay the bill is they don't have $800 or $1,000 or something like that that's available, and it strikes me that part of that is just going to be it's high, it's hard to pay. But also, maybe by the time they get a look at it and get the bills, there's a bunch of bills and they add up to a higher number and I understand some of the research shows that people have a lower balance. They're more likely to pay it than a higher one. There's like a $500 threshold or something. How does that work into what you do and to a collection strategy from a provider? 

0:14:37 - Tom Furr
We have a number of clients, like in the radiology space, that can have very big bills or fertility. One of our clients is progeny, which is one of the largest, most innovative fertility group out there. They have very big bills. We have to offer patients the ability to pay when and where and how they can. And when I say they might need that payment spread out over a certain period of months because they have an HSA card, but an HSA card only has a certain amount of dollars on it each month that you or your employer put in onto it. You might need a payment plan to your very point. I don't have $500 sitting in the bank right now, so I need it over five months to be able to pay $100 a month. 

There are various use cases that you have to do to help patients pay their bill. Again, understand it, make it easy to pay and meet them where they need to be met. When it comes to the ability to pay and it is an interesting phenomenon that's taking place that if you give people the ability to pay it, all of our clients today don't charge interest, so you see your amount going down each month, which we really respect. Those that don't do that, and so the patient can say, okay, it was 500, now it's 400. Over the next four, four months, it'll be zero. 

We feel strongly. Patients want to pay their bill. You just have to give them the ability to pay it and understand it enough, uh, so that they want to pay it. But they, they clearly are committed to supporting their medical doctor or facility. I mean, no one wants to short your hospital who helps you in time of need. So it's a challenge and and it will continue to be the challenge, because health care does continue to take a big part of the GDP it's almost 20 percent. So you need to help people meet the needs that they're having. 

0:16:28 - David Williams
Tom, you mentioned before that you've got patents I think four patents, which I think is up. From last we spoke, I think there were only two or three. What's the strategic value of having patents? Why do you need a patent for someone to give you money? 

0:16:43 - Tom Furr
The challenge in healthcare is getting all that data out of these traditional systems that are in healthcare so that you can create a bill that's easy to understand. And what we did is for some clients. We leveraged the claims infrastructure, which normalizes all the data for insurance companies. It's actually very efficient. So to take the data out of a system but apply what needs to be applied to the patient versus to the insurance company. We were the first person to think, hey, why don't we repurpose this infrastructure designed for insurance companies for patient payments? And so we were issued patents two or three of them back in 2012 and another one in 2019. 

That kind of built around that and we are very proud of our innovative approach to getting the data out, simplifying the data. It's like an iPhone, right? You look at an iPhone. It's so easy to use, but the complexity behind the iPhone is enormous. And we try and look at patient pay the same way. Let's simplify things. Let's don't make it more complex. Let the systems on the back end take the complexity and make it simple for patients. And that's how we really backed into that patent, because we're trying to find an easy way to get data out so that we could create a bill that you could fully understand. 

0:18:05 - David Williams
Got it Well. Now let's talk about ClearGage, which is a very exciting opportunity coming together of a couple of companies, before we talk about the merger itself. What does it mean to have a healthcare estimate and payment solution? 

0:18:21 - Tom Furr
So one of the things that ClearGage was one of the early, early companies to approach the estimation and eligibility solution. So what an estimation solution does is it says based on your Blue Cross, blue Shield, north Carolina or Massachusetts or wherever insurance plan, we're estimating that you will owe $50 for this procedure. But to take one step in front of it, you need to say well, what about eligibility? Are they even still a Blue Cross member or have they moved to UnitedHealthcare? So they built a solution to help medical groups get a patient before they show up. Say Tom Furrier yes, he has this insurance plan and based on where Tom Furrier is in his high deductible plan, he's going to owe the full amount, a portion of it or what have you. So that Tom can go in eyes wide open and understand I need to prepare for whatever I'm getting ready to have done financially and I need to be able to have a way to pay this bill. So then they would allow them to pay through patient pay through a payment plan maybe, and they start it earlier in the process and later Maybe they pay the full amount, or maybe they they set up other ways for them to pay the bill, but at least Tom walks in and loves the service, loves everything that the doctor did for me. 

But I'm pretty upset because I got shocked with this bill at the 11th. You know, after I've gone of $2,000 or whatever. Now I'm going okay, great, I'm expecting to pay 2000. It might be a thousand or 1500, but at least there's an expectation set. I have great service, have great, you know, walk out the door and I'm healthy and everything's going great. And then I get the bill and there's not as much of the shock there, or I start paying it up front so that I can have the ability to manage it over whatever period of time I need to manage and to meet my HSA accounts or other way of paying. 

0:20:28 - David Williams
So for patient pay. What's nice about what's nice about revenue cycle management and one reason investors love it. You're dealing with money and you can see if you help a provider bring more money in. They're going to be willing to pay you for that and they can measure it what percent of the outstanding balances are collected. They can do a pre and post comparison. How do you measure the success of a healthcare estimation business? How does the customer know they're getting value from that? 

0:21:00 - Tom Furr
Well, it gets right back to what you just said and the estimation now says okay, we were supposed to collect a hundred percent from this patient. We collected a hundred percent or we collected less than 50%, which is the norm in health care. In fact, we see certain verticals, specialties, that collect less than 20 percent of every dollar they bill, and so the ability to even get them which we do to 35 or 40 percent they're excited about it's still only 40 cents on the dollar that you're collecting. So we always ask ourselves well, that's not acceptable. We need to move this in towards a hundred percent so to be able to get those dollars started earlier to a payment plan, the propensity to pay is shown that patients will follow through to pay the whole thing once you get them started on it. 

So there's a lot of strategies around leveraging one, the knowledge to a patient so that they can again prepare and understand. Two, getting them set up on a payment plan so it's just rolling automatically every month. And three, making sure that if there are additional fees that come out, once it's adjudicated that you explain that in a bill. Look, it was supposed to be $2,000. It's now $2,200 because certain services happened that hadn't been planned. So it just makes it a lot easier for patients to understand why they're being billed, appreciate why they're being billed and, of course, pay it at the end of the day. 

0:22:35 - David Williams
Got it, so it enhances the value of patient pay. That's right Because you can start the process earlier. It's more predictable from the start and maybe before someone is. It's one thing. You're recovering from surgery and you get a bill you weren't expecting and you're trying to get your life together, and all that. If you knew beforehand what it was, then you're in better shape. When you have something like this estimator, does it impact whether people actually get care, and is that a negative? Or I mean it could be a positive from the physician standpoint, I suppose, if someone who's not going to pay decides not to have care. But I could also see it being a problem from an access and an outcome standpoint. 

0:23:20 - Tom Furr
David, you touched on something that historically, medical groups, hospitals, have been a little bit apprehensive to provide up front because, to your point, they're afraid they won't get care and the you know, the new laws coming out of out of Washington are stating that there needs to be transparency when it comes to cost and and in fact there's some regs that they're finalizing now and will be at some point pushing down to medical groups that say you know, you can't have these surprises when they get patients, can't have these surprises when they get their bills. 

So we feel like, at the end of the day, yes, you might lose some people, but the experience from a patient perspective will be better and hopefully they don't, because these medical groups want to help you get better. They will find ways to get the bill paid, but you need to have some expectation going in so you don't have that again surprise of wow, I didn't know I had to have that. Now I'm a bit upset. You know I had great care. So we think at the end of the day, it'll be a good thing for patients and medical groups or hospitals. 

0:24:40 - David Williams
Now I'm interested about how this merger came together. Sometimes a banker is shopping a company around and it's a good fit you're looking to acquire. I'm wondering in my mind if this is one where there were some providers that were actually using both services and it made sense to put them together. But I'm just making a wild speculation. How did it come to pass so? 

0:25:03 - Tom Furr
we were introduced to the family office that owned Clear Gage and there's going to be, in our opinion, a lot of movement in the space in the next 18 to 24 months and so we're trying to be out in front of the movement. And so when we started talking we realized that there was a lot of similarities. They were more in the chiropractor or more in the physical therapy and they were here. We were in radiology and so we both were touching similar markets but different. So it gave us a much broader reach into various markets out there. We realized that they had some good technology on the estimation and eligibility front that we didn't have. We've got some good technology on the billing and payments front. 

We realized they had a what's referred to in the payments world, a pay fact which helps us control the payments more, which we didn't have. So the more we talked and the more we got to know each other over the last four or five months, we kind of said you know, there's a lot of opportunity for us to come together and you know the old deal world language one plus one equals three. We think one plus one is going to equal four, but we're excited to get it done Clear Gage has been doing this as long as we have, like a lot of people, and we feel it will continue to build on our platform so that we get more medical groups, more patients. That will ultimately lead to more medical groups and more patients as we grow both user bases that are out there. 

0:26:42 - David Williams
My last question for you, tom, is if you've had a chance to do any reading lately, if you read any good books that you would recommend to our audience and, of course, if you've read something terrible that we should avoid, let us know about that as well. 

0:26:54 - Tom Furr
Yeah, I just finished the Elon book and it was quite interesting. 

There was a few things that I got out of that book from an entrepreneur perspective that were really intriguing at how he looks at cost in a very detailed, not high level, you know he's like how do we cut the cost of this to continue to drive value to the clients? And it kind of opened my eyes of there are things that you can do with technology. There are things that you can do with other areas to drive more efficiencies, other areas to drive more efficiencies and we've been looking at I think he referred to it as his algorithm, his personal algorithm, you know, but I found it. You know you think of something like that as just technology, but it's not. It's about the whole component of business, and cost are a key part of it, and the more you can contain them, the more you can bring down your costs and still make lots of profits. So we continue to try and automate as much as we can so that machines do more than the manual work that needs to be done out there. 

0:28:10 - David Williams
Well, that book was recommended to me as well and I read it and I got a lot out of it as well, and I found it's also been helpful of understanding some of his recent maneuvers, in particular when he laid off everybody from the supercharger unit, which seems ridiculous and crazy. It seemed it sort of fit and then he hired some of them back. That goes along with the algorithm as well. So I recommend that book as well and we'll see where he goes. I'm sure it's not the last discussion for Elon Musk. Well, tom, for a founder and CEO of Patient Pay getting ready to merge with ClearGage. Thank you so much for joining me today on the Health Biz Podcast. 

0:28:51 - Tom Furr
David, thank you so much, and hopefully it's not as long the next time we get together. 

0:28:59 - David Williams
You've been listening to the Health Biz Podcast with me, David Williams, President of Health Business Group. I conduct in-depth interviews with leaders in healthcare, business and policy. If you like what you hear, go ahead and subscribe on your favorite service. While you're at it, go ahead and subscribe on your second and third favorite services as well. There's more good stuff to come and you won't want to miss an episode. If your organization is seeking strategy consulting services in healthcare, check out our website, healthbusinessgroupcom.