• Warris Bokhari founded Claimable to tackle insurance-claim denials using AI technology.
• Bokhari says denial is a major issue in the US healthcare system, causing fear about getting help.
• Claimable's AI-driven platform boasts an 85% success rate in overturning claim denials.

After working in the insurance industry, Warris Bokhari saw that claim denial was a core issue in American healthcare.

So around two years ago, Bokhari started working on Claimable, an AI startup launched in October that aims to fight claim denials for a growing list of treatments.

"It's no wonder why people give up," the Claimable cofounder and CEO told Business Insider. "If you're a rational person, you would say this model was not fit for purpose."

Bokhari was raised in the UK and grew up with two disabled parents. Unlike people in the US, his parents never went bankrupt because of medical expenses, he said. He went on to work as an ICU doctor in the UK, where, he said, there was "never a time" when a necessary treatment was denied to a patient. When he came to the US, Bokhari continued working in the healthcare industry, including a two-year stint at insurance company Anthem.

In the US, he said, "there's no guarantee" of getting the medical care you need. Insurance companies can end up feeling like an obstacle, and that dynamic has created "fearfulness" about getting sick and seeking out help, Bokhari added.

The insurance industry has faced renewed scrutiny amid the fatal shooting of UnitedHealthcare CEO Brian Thompson. While the motive behind Thompson's killing is under investigation, many of the responses to his death online have disclosed deep frustrations with the insurance industry.

Bokhari said the company didn't support violence toward individuals. "That is not the productive solution," Bokhari said. "The productive solution is appealing."

Claim-denial rates have been increasing for more than a decade. The health policy and research firm KFF reported that 17% of in-network claims by HealthCare.gov insurers were denied in 2021. The same report found that 41% of appealed claims got overturned, though less than 1% of consumers went through the process. Recent criticism has also been directed toward insurance companies that can rely on algorithms to assist in claim decision-making.

Bokhari said that Claimable had helped file hundreds of appeals and that its success rate of overturning denials was about 85%. It joins several startups leveraging AI to improve the insurance process.

Patients start by describing their experience of living with the condition and what it would mean to get denied their requested treatment. The platform then uses AI to analyze millions of data points from clinical research, appeal precedents, policy details, and the individual's medical history to generate a customized appeal within minutes.

Most Claimable appeals cost patients $39.95, plus shipping.

Claimable supports claims appeals for more than 70 FDA-approved treatments for autoimmune and migraine sufferers, some of which may have been denied because of medical necessity or being out of network. In addition to faxing and mailing the appeal to the insurance company, Claimable also sends a copy to every regulator that would have oversight of the insurer.

"Regulators probably assume that these denial cases are occasional," Bokhari said. "They make big headlines, but they don't know that these very private tragedies happen every day in American life."

Bokhari said patients "have a right to be heard," and Claimable helps legitimize those patients' stories.

Claimable closed its seed round in March, backed by Walkabout Ventures, Humanrace Capital, and others. The company is a part of Nvidia's startup program and has a team of about 11 employees.

• Health insurers are coming under fire for increasingly denying patient claims for medical care.
• Investors are rushing to back startups using AI to automate the complex healthcare billing process.
• These 10 startups are helping patients, providers, and insurers improve health payments with AI.

In the wake of the fatal shooting of UnitedHealthcare's CEO last week, public hostility toward health insurers has reached a boiling point.

After Brian Thompson was shot and killed in Manhattan on December 4, social media exploded in morbid celebration. Shell casings found at the scene of the crime reportedly showed the words "deny," "defend," and "depose," mirroring a phrase commonly used by insurance critics to describe tactics used by health plans to avoid paying claims. Suspect Luigi Mangione was arrested Monday with a note in his possession containing the line, "These parasites had it coming."

It's a reckoning for how healthcare in the US is paid for — or not paid for — as health insurers increasingly deny paying for patient care. UnitedHealthcare and other health insurers have come under fire in recent years for using algorithms to deny patient claims, particularly Medicare Advantage claims. Claim denial rates have been on the rise for more than a decade, and denied or delayed payments cost hospitals hundreds of billions of dollars a year.

A growing crop of startups think AI can help.

Investors are rushing to back startups using AI to help providers, patients, and health plans more accurately and efficiently pay for medical care.

These 10 startups are using AI to automate key parts of healthcare's complex billing process, from prior authorization to claims adjudication.

Alaffia Health

Founded: 2020

Total raised: $17.6 million

What it does: Alaffia Health works with health plans to automate time-consuming tasks in claims processing, such as reviewing large patient medical records and policy documents. The startup says its generative AI tools can help insurers supercharge their in-house clinical teams and reduce claims spending.

Alaffia Health last raised a $10 million Series A round in April led by FirstMark Capital.

Anomaly

Founded: 2020

Total raised: $30 million

What it does: Anomaly uses machine learning to parse health insurers' policies and historical claims data to help clinicians predict and prevent claims denials. The startup was incubated by Redesign Health and has raised money from investors like RRE Ventures and Madrona.

Anterior

Founded: 2023

Total raised: $23 million

What it does: Anterior provides tech to clinicians working inside health insurers to automate prior authorizations for covered medical care. The startup raised a $20 million Series A led by NEA in June. It's also backed by Sequoia Capital and Microsoft AI head Mustafa Suleyman.

Claimable

Founded: 2023

Total raised: Undisclosed

What it does: Claimable launched in October to assist patients in creating appeal letters for denied medical claims. Its platform analyzes a range of data, including clinical research, insurer policies, and existing appeals data, to generate a personalized letter for $40.

The startup last raised a seed round from Walkabout Ventures, Humanrace Capital, and other investors in March. It's also part of Nvidia's startup accelerator program Inception.

Cofactor AI

Founded: 2023

Total raised: $4 million

What it does: Cofactor AI's platform analyzes information, including medical records, insurer policies, and claims data, to help hospitals appeal claims denials. The startup announced a $4 million seed round led by Drive Capital in November.

Cohere Health

Founded: 2019

Total raised: $106 million

What it does: Cohere Health contracts with health plans like Humana and Geisinger to automate prior authorizations for medical care. The startup claims its tech can reduce the number of unnecessary prior authorization denials to help patients get the care they need faster. Cohere Health last raised a $50 million Series B extension in February led by Deerfield Management.

Humata Health

Founded: 2023

Total raised: $25 million

What it does: Humata Health works with hospitals to automate the collection of documents included in requests for prior authorizations sent to insurers and flag likely denials. The startup raised a $25 million Series A in June, led by LRV Health and the Blue Venture Fund.

Dr. Jeremy Friese started Humata Health after serving as the president of health AI startup Olive, which shut down last year after selling its prior authorization business to Humata.

Goodbill

Founded: 2021

Total raised: $5.3 million

What it does: Goodbill works with patients and employers to reduce medical costs by cross-referencing medical records with incoming hospital bills to identify potential errors and overcharges. The startup last raised a $2 million funding round in March from Founders' Co-op, Maveron, and Liquid 2 Ventures.

Guardian AI

Founded: 2024

Total raised: Undisclosed

What it does: Guardian AI provides hospitals and physician groups with tools to analyze insurance reimbursement patterns and automate the handling of unpaid medical claims and denials. The startup was part of YCombinator's summer 2024 cohort; its founders previously worked on Palantir's AI revenue cycle management programs for hospitals.

Thoughtful AI

Founded: 2020

Total raised: $40 million

What it does: The startup's AI agents help healthcare clinics process medical claims, check patient insurance coverage, and record payments. Thoughtful AI last raised a $20 million Series A in July, led by Drive Capital.

• Many workers struggle with choosing their health-insurance plans during open enrollment.
• Some healthcare companies are employing mobile apps and generative AI to help smooth out the process.
• This article is part of "Trends in Healthcare," a series about the innovations and industry leaders shaping patient care.

During open-enrollment season, Reddit users inundate the platform's forums on health insurance and personal finance every day, asking how to best pick from their health-insurance options.

In one post, a recently unemployed married woman in Texas asked whether she should enroll with her husband's employer or stick to COBRA, which provides benefits to people who have lost their jobs. Another married person requested advice on which coverage to pick if they're planning to have a baby in 2025. For an employee in California, fellow Redditors were a sounding board as they navigated dental-plan options, with costs ranging from $0 to nearly $440 annually.

Open-enrollment season typically takes place between October and December, and companies have their own set periods within those months. During this time, Americans elect their health-insurance coverage through either a private employer or marketplaces via subsidies offered under the federal government's Affordable Care Act. Nearly all open-enrollment selections made this fall will go into effect on January 1 and be set until the following season, with a few exceptions.

The process can be immensely confusing.

Employees are expected to look both backward and forward, said Dan Beck, the president and chief product officer for SAP SuccessFactors, a cloud-based software platform that oversees HR, payroll, and talent management.

He told Business Insider that employees are tasked with reflecting on whether they maximized their benefits in the past year based on how much they tapped into the healthcare system. At the same time, they must anticipate health-related events, such as having a child or a major surgery.

To complicate matters further, workers may move to new roles with different insurance options or their employers could change providers or plan options, forcing employees to acquaint themselves with new choices. The makeup of their families could change, too: As employees' marital statuses change and they raise children, they'll likely want to optimize their healthcare plans for those life stages.

On Reddit, people making health-insurance decisions try to make sense of the complexities. If they choose health plans mismatched with their needs, they run the risk of overspending in two directions: shelling out for a premium-coverage plan they don't really need or skimping on coverage and then experiencing an expensive life change.

Employees also need to keep track of life events that could change their coverage, including moving, having a baby, or adopting a child. There is a special enrollment period, outside of open enrollment, for those life events, but also a limited period of time to make the changes and retain health care coverage.

Increasingly, employers are encouraged — by both their employees and their HR-benefits companies — to share more easily digestible benefits information.

"What employees are telling us, overwhelmingly, is that they need help when they are enrolling," Karen Frost, a senior vice president at the cloud-based employee-benefits vendor Alight, told BI.

Some employers are partnering with third-party companies that handle things like payroll and health benefits and have built software with with clear step-by-step prompts — which can help workers be confident about their healthcare elections.

Young workers want more employer support in demystifying healthcare

In Alight's 2024 annual survey of 2,500 employees in the US, the UK, France, Germany, and the Netherlands, 63% of workers said they felt confident about their most recent health-plan election.

There are, however, some generational splits in the data. In the survey, 70% of Gen Z and 72% of millennial workers said they wanted personalized support for navigating the health system versus just 46% of baby boomers.

Before the mass digitization of benefits elections, employers would hand their employees printed packets outlining their medical-insurance offerings and ancillary benefits such as dental and vision, retirement plans, commuter reimbursement, gym memberships, and other wellness programs. Employees would pick from that menu, largely without guidance or input on what they'd like to see as alternative or additional benefit options.

Though the paper-packet method is much less common now, the enrollment process can still be overwhelming to navigate.

Life changes, like moving to a new state or employer, or a company picking new insurance providers to work with can complicate the enrollment process.

"You have a narrow window to actually get benefits, and you want to be successful," Beck told BI.

Mobile apps and generative-AI tools aim to smooth out the open-enrollment process

To help employees sort through their options during the open-enrollment period, some healthcare startups are leveraging mobile apps and generative-AI chatbots.

Alight, for example, aims to learn more about employee preferences and the needs of their families through a Q&A and then make recommendations. Throughout this process, Alight's recommendations coincide with clear definitions of complex benefits, like a health savings account, which lets workers set aside pretax money for qualified medical expenses.

"Instead of just letting people make their own choice, we guide them," said Frost. As an example, if an employee were to pick a high-deductible health plan, Alight would guide them to an HSA and explain why enrolling in it may make sense to budget for potential healthcare expenses.

SAP SuccessFactors said it's not yet comfortable with offering suggestions for health-insurance elections, citing concerns about data privacy.

Instead, the company — which has customers including McDonald's, L'Oréal, and Delta Air Lines — said it's focusing on further developing its recently launched mobile app.

The SuccessFactors mobile app is targeted at two demographics: workers under 40 who tend to be mobile-first in nearly every aspect of their lives and frontline workers of all ages with jobs in manufacturing and other sectors where they may be without frequent access to computers.

SAP SuccessFactors is also using generative-AI chatbots to answer policy questions to improve the user experience. In the future, the company plans to use these chatbots to automate some open-enrollment processes.

To bolster the company's abilities to help employees navigate this process and other healthcare questions that may arise throughout the year, SAP earlier this year paid $1.5 billion in cash to buy WalkMe, a tool designed to provide real-time website navigation for healthcare, onboarding, and other employee-focused tasks.

AI-based virtual assistants are also becoming more pervasive in the open-enrollment process. Alight has Ask Lisa, SAP SuccessFactors is leaning on the company's artificial-intelligence copilot, Joule, and the HR- and financial-software provider Workday uses Wex, an AI chatbot that internal employees can access on Slack to get automatically generated responses to their benefits questions. The same tool is offered to customers but branded as Workday Assistant.

"We try to appeal to all generations and age groups," Ben Carter, the senior vice president of business partners and rewards at Workday, said. "Some people, the last thing they want to do is actually talk to somebody on the phone."

This emerging technology benefits employers, too. Earlier this year, Workday unveiled an AI-enabled tool called Workday Wellness, which integrates with insurance providers like Aetna and Cigna. It allows Workday's customers — like The Hartford, Guardian, and MetLife — to understand which wellness benefits employees are using and which ones aren't resonating so they can invest more strategically.

"It brings a nice story," Carter said, "to say, well, if I'm going to go invest another $20 million in my benefits programs next year, here's where I need to go, or here's where I need to double down, or here's where I need to stop investing."

• Officials reportedly found bullet casings with the words "deny," "defend," and "depose" on them at Brian Thompson's murder scene.
• The words are similar to the title of a 2010 book about the insurance industry, "Delay Deny Defend."
• Police have not yet shared a motive for the shooting.

The gunman who shot Brian Thompson, the CEO of UnitedHealthcare, reportedly left behind a cryptic message at the crime scene.

Update: A "person of interest," 26-year-old Luigi Mangione, was arrested in connection with Thompson's death in Altoona, Pennsylvania, on Monday.

Multiple news outlets said that the shell cases found at the scene were inscribed with the words "deny," "defend," and "depose." These words are similar to the title of Jay M. Feinman's 2010 book "Delay Deny Defend: Why Insurance Companies Don't Pay Claims and What You Can Do About It," causing speculation that the shooter may have been referring to it.

The phrase "delay, deny, defend" is also common among lawyers who say that insurance companies delay the claims process with paperwork, deny claims that should be covered, and then defend themselves in court if a claimant pursues legal action.

The suspect of Thompson's shooting was still on the run as of Friday afternoon. Police haven't shared a motive behind the killing, which took place Wednesday morning.

Feinman, an author and professor emeritus at Rutgers, wrote about the insurance industry's evolution and shared advice for consumers on handling disputed claims in his book "Delay Deny Defend."

An NYPD spokesperson declined to comment when asked if police were investigating any link between the book and the shooting. The author also declined a request for comment.

Here are some of the key takeaways from Feinman's book.

There's only one mention of UnitedHealthcare by name.

While Feinman mentioned several top insurance companies by name throughout the book — State Farm and Allstate in particular — UnitedHealthcare only appeared once.

In the introduction, Feinman described how, in 2009, UnitedHealth, Aetna, Guardian, and other companies agreed to stop using certain databases to calculate fees for out-of-network treatment after being accused by then-New York Attorney General Andrew Cuomo of systematically lowballing patients.

Feinman says the insurance industry changed in the early 1990s.

In the intro to his book, Feinman wrote that insurance companies began to significantly reconsider the claims process in the 1990s when they "became a profit center rather than the place that kept the company's promise."

A major part of this shift occurred when insurance companies, including Allstate in 1992, hired consulting giant McKinsey & Company, he said.

McKinsey developed new strategies for handling claims and saw it as a "zero-sum game," Feinman writes. The insurance companies started using computer systems to estimate the amounts to be paid and deterring claimants from hiring lawyers, he said.

McKinsey declined Business Insider's request for comment.

Insurance companies aren't friends — but they're also not the enemy, he wrote.

Feinman said in the book that insurance companies aren't our friends — but they're not our enemies, either.

That's because companies must pay claims "pretty well most of the time" to stay in business.

"The point of view in this book is pro-consumer but it is not anti-insurance," Feinman writes. "Insurance is essential to our economic security." However, to serve as "the great protector of the standard of living of the American middle class, prompt and fair claim handling has to be the rule," he wrote.

'Understand your coverage. Understand the claims system. Get help if you need it.'

In Chapter 11, Feinman outlined what consumers can do to protect themselves while also seeking ways to cooperate with insurance companies.

He wrote that the responsibility to fix the system shouldn't fall to consumers alone. Legislators, regulators, and the courts must also step in, he wrote.

Feinman's advice boiled down to three key tenets: consumers should research the reputation of their agencies and policies carefully, understand the claims system, and seek legal recourse when necessary.

On Wednesday, moments after the news broke that Brian Thompson, the CEO of UnitedHealthcare, had been fatally shot in Midtown Manhattan, social media unleashed a barrage of caustic commentary about his death. In lieu of condolences, Americans from all walks of life shared barbed jokes, grim memes, and personal anecdotes about their own experiences with giant insurers like UnitedHealthcare.

On Facebook, UnitedHealthcare's statement about the murder of its chief executive elicited 46,000 reactions — 41,000 of which employed the laughing emoji. The company quickly turned off comments on the post, but hundreds of users shared it with arch commentary.

"The amount of laugh reacts on the original post speaks volumes lol," one user wrote.

"My thoughts & prayers were out of network," wrote another.

While the motive behind Thompson's murder remains unknown, the internet treated it as an occasion for ghoulish schadenfreude. America's health insurance system is so broken and cruel, people openly declared, that the death of one of its most powerful executives merited nothing but scorn and derision. "He was CEO when he was shot," read one tweet that received more than 120,000 likes. "Preexisting condition. Claim denied."

"The UnitedHealthcare CEO might be the most celebrated death on this app since Henry Kissinger," wrote another user on X.

Given the nature of social media, where the most provocative and emotion-laden commentary is engineered to rise to the top, it's not surprising that platforms from TikTok to Reddit would be filled with hateful invective. What's striking, however, is how the backlash revealed the depth of the bitterness toward health insurers. In the face of a man being gunned down in the street, people didn't keep their feelings toward insurers in check; rather, they seized on it as a moment to vent their rage. Everyone from right-wing influencers to tenured Ivy League professors responded to Thompson's killing by posting about what they saw as the injustices of America's health insurers. Even on LinkedIn, one of the internet's last bastions of civility and professionalism, hundreds of business executives, HR leaders, and tech managers shared deeply personal stories about how they and their loved ones had suffered at the hands of a healthcare bureaucracy that often delays and denies reasonable claims.

In one exchange, a hospital executive acknowledged that many Americans are fed up with health insurers. "As healthcare security professionals, we know that many see healthcare as a target for their anger," he wrote. "Family members who have lost a loved one may feel as though a physician, healthcare facility, or insurer is responsible for that loss."

Jill Christensen, a former vice president at Western Union, responded to the post by forcefully rejecting its wording. "In many instances, it's not feel, it's ARE responsible for that loss," she wrote. "I was diagnosed with Stage 4 cancer and UHC denied every claim. While today's event is tragic, it does not come as a surprise to the millions of people — like myself — who pay their OOP costs and premiums, only to be turned away at their greatest time of need."

The joking language of the internet has become a standard way for Americans to process tragic events, whether the September 11, 2001, attacks or the July 2024 assassination attempt on Donald Trump. But Thompson's murder sparked something different: an unparalleled public reckoning with one of the country's largest and most profitable industries. "When you shoot one man in the street it's murder," wrote one user on X. "When you kill thousands of people in hospitals by taking away their ability to get treatment you're an entrepreneur."

To some observers, the outpouring of ire also appeared to have an immediate effect on the industry itself. One day after Thompson's murder, Anthem Blue Cross Blue Shield announced that it was rescinding a controversial plan to limit coverage for anesthesia. "When patients become financially responsible because a health plan cuts how much they pay providers, that's what breeds all this anger," Marianne Udow-Phillips, a former Blue Cross executive, told Axios. An Anthem Blue Cross Blue Shield spokesperson told Business Insider, "It never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services. The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines."

The storm of invective surrounding Thompson's killing will soon subside, as online malice always does. But it's also possible that the CEO's death will mark an inflection point in the debate over America's privatized system of health insurance. On X, one user drew a direct line between the callousness of the internet's response to Thompon's murder and an industry that makes it hard for many Americans to receive the medical treatment they need.

"All jokes aside," the user tweeted, "it's really fucked up to see so many people on here celebrating murder. No one here is the judge of who deserves to live or die. That's the job of the AI algorithm the insurance company designed to maximise profits on your health."

Scott Nover is a freelance writer based in Washington, DC. He is a contributing writer at Slate and was previously a staff writer at Quartz and Adweek covering media and technology.

• Andre Nader switched from an EPO health insurance plan to an HDHP to get access to an HSA.
• Nader found the mental burden of managing healthcare costs outweighed HSA tax benefits.
• He plans to switch back to an EPO plan in 2025 for simplicity.

Andre Nader spent years on Meta's growth team, where his work involved experimentation and testing to determine how to improve specific products.

"I like to use that same testing methodology in my own life," the 37-year-old founder of financial independence blog FAANG FIRE told Business Insider. After getting laid off in 2023, Nader didn't have to job search thanks to the seven-figure net worth he built after years of investing in index funds and transitioned to writing on Substack full-time.

In 2024, he decided to put the popular, triple tax-advantaged health savings account (HSA) to the test. One requirement of using an HSA is that you must have a High Deductible Health Plan (HDHP), so he switched his family from an EPO health insurance plan, which he'd used for most of the past decade.

Nader said the EPO plan would be the simpler choice for him and his family — he wouldn't have to think about deductibles, the co-pays would be low, and all major hospitals were in-network — but he couldn't help but wonder if the savings from having an HSA would outweigh the extra hassle of having an HDHP, which offers a lower premium but comes with a higher deductible.

The benefits of using an HSA, which he describes as a "magical account," were obvious to him. It is a unicorn in that it offers a triple tax benefit:

1. You can contribute pretax dollars, which reduces your taxable income.
2. You can invest your HSA funds (the investment options vary by provider), and your contributions and earnings grow tax-free.
3. You can withdraw your money tax-free to cover qualified medical expenses (including things like copays, lab fees, and vaccines). After 65, you can use your HSA money to cover any expense without incurring a penalty, but the funds are subject to income tax.

Consider other tax-advantaged accounts. With a Roth IRA, you contribute after-tax money (and eventually withdraw it tax-free); with a traditional 401(k), you contribute pre-tax money (and eventually pay taxes when you withdraw).

"It's very rare to have an account where you're putting money in pre-tax and then also taking it out without paying taxes on it — and the entire time it's there, it can grow tax- and penalty-free," said Nader.

To maximize HSA gains, investors will invest their funds (rather than letting their HSA money sit in a cash account) and avoid touching it so it can grow and compound over time. Not touching your HSA funds means covering your medical expenses out of pocket, which is what Nader did throughout 2024. He saved all of his receipts from health-related expenses, so he'd have the option to reimburse himself later if he needed to (there's no time limit on when you can reimburse yourself from your HSA).

"In a spreadsheet, this is very lucrative," he said of taking full advantage of an HSA. Some companies will even contribute a certain amount to their employees' HSAs, which is essentially free money. "However, life isn't always about what happens in a spreadsheet."

Changing his coverage in 2025: 'I don't want to be living a life where I'm thinking about the cost of my healthcare'

As Nader's year of experimentation comes to a close, he's confident that an HDHP is not the right fit for his family and is switching healthcare plans in 2025. He says he'll likely go back to using an EPO.

"Even though the HSA is an amazing account that I can grow tax- and penalty-free forever, for me, the incremental benefit wasn't there," he said.

His main issue with using an HDHP and HSA was the mental bandwidth it required.

"The reason you're saving so much is you need to actually be thinking about your medical expenses more," said Nader. "Every single time that you go to urgent care, you're paying out of pocket until you hit a deductible or your out-of-pocket maximum. Every single time you go to a specialist, you're paying out-of-pocket until you hit your out-of-pocket maximum. So there was a lot more mental overhead in thinking about my healthcare decisions."

He felt like he couldn't be on autopilot like he was with an EPO plan, where an urgent care visit may cost him $10. With an HDHP, that same visit may cost hundreds of dollars, enough to stop and think about whether to get care.

"What's been happening over this year is, every single time I've needed to go to urgent care, I've thought about it a little bit, and I really didn't like that my health decisions were intersecting with my financial decisions," he said. "I didn't want to think about whether I should go to the emergency room if I had a cut; I should just go to the emergency room and not factor in the expenses."

At the end of the day, "I don't want to be living a life where I'm thinking about the cost of my healthcare."