By replacing a legacy clearinghouse and manual eligibility checks with Office Ally’s Eligibility Verification and Insurance Discovery, Soar Autism Center was able to reduce denied or underpaid claims, protect patient families from high costs and free staff to focus on patient care rather than rework.
Finding Hidden Secondary Coverage
Soar’s early‑intervention model means each child may have multiple active plans hat change frequently. Oftentimes, secondary sources of coverage come from a state Medicaid plan or other commercial plan.
“The most common thing we discover is either the family forgot to tell us about something,” said Ian Goldstein, Co-Founder & CEO at Soar. “Or, often with Medicaid, the plan has gone inactive; there are a lot of reasons why the family may not be aware of coverage.”
Rapid expansion from 1 to 20+ centers multiplied the risk of missed coverage, slower cash flow and higher out‑of‑pocket costs for families. Soar billing staff found out about secondary sources of coverage after already billing the primary insurer, leading to hours of rework on claims.
Making a Change
Soar previously used a common EHR solution in autism care. That solution’s built‑in eligibility check ran exclusively through another clearinghouse, but a cyberattack forced Soar to switch vendors.
“We kind of hung on for a little bit,” said Goldstein. “We kept waiting and waiting. Then, eventually, we decided that we needed to make a change.”
Soar services a small number of young patients who come often for regular therapy. This unique setup means most off-the-shelf tools, suited for larger hospitals and health systems, are not as effective in autism care.
Goldstein needed a tool that made sense for Soar’s patient population while being easy to set up and customize. After all, Soar had not planned to change vendors or tools at all, so a low-friction transition became a high priority.
Beneficial for All Parties
Soar Autism Center has used Office Ally’s Eligibility Verification and Insurance Discovery for over a year, reporting great satisfaction.
“Even though we know our families very, very well, we are finding insurance coverage things that we did not know about,” said Goldstein. “And sometimes even the family didn’t know about it. That helps us from a financial perspective by making sure that we’re able to collect for the services that we deliver.”
Goldstein’s team also appreciates the reduction in out-of-pocket costs for families. Steep deductibles can be challenging, but secondary insurance sources can ease the burden and allow therapy services to continue without interruption.
Soar continues to grow, with plans to expand into new states. The center will continue using Office Ally to protect reimbursement and save families money with insurance checks.
“As you grow, your needs evolve,” Goldstein said. “There’s just more. There are more people, there are more teammates and there’s more risk of things falling through the cracks. These tools are a nice secondary check to ensure that we’re capturing everything that we can, we’re meeting our compliance guidelines and we’re reducing rework down the line for our team.”
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