Navin Nagiah and Prateesh Maheshwari on Cutting Out-of-Network Costs by 80%

Health plans spend millions every year paying middlemen a cut of "savings" on out-of-network claims, savings calculated from a rack rate nobody ever expects to be paid. Daffodil Health is automating that process end to end and cutting out-of-network repricing costs by about 80%.

In this episode of Care Shift, Navin Nagiah (Co-Founder and CEO, Daffodil Health) and Prateesh Maheshwari (Managing Director, Maverick Ventures) break down how out-of-network claims really get paid, who ends up bearing the middleman fee, and why Daffodil walked away from the percent-of-savings model even though it means giving up 50 to 60% of potential revenue. Navin draws on his years at MultiPlan to explain why incumbents can't make this shift themselves, and Prateesh shares what he learned running finance at Oscar Health and why Maverick backed Daffodil at seed and again at Series A. We also cover the No Surprises Act, where AI fits in claims pricing, and who ultimately captures the value.

CHAPTERS 00:00 Welcome Navin and Prateesh 00:06 What Daffodil Health does 02:42 Following a $30K out-of-network claim 03:52 Who really pays the middleman fee 05:52 Out-of-network costs at Oscar Health 07:34 What is a rental network? 09:16 How middleman fees squeeze health plan margins 11:07 The $10M margin opportunity for mid-sized plans 12:13 Why cost containment startups never broke out 15:29 Choosing trust over short-term revenue 16:48 Why MultiPlan can't build this in-house 19:53 How incumbents fight back 22:01 The problem with percent-of-savings pricing 24:03 Pricing shifts and backing spinout founders 27:25 Maverick's seed diligence 29:39 Giving up revenue by design 31:23 Will percent of savings die? 33:29 Landing the first design partners 38:35 Vendor selection lessons from Oscar 40:15 Regulation, press, and the No Surprises Act 43:32 How the No Surprises Act works 45:57 Where AI fits and where humans stay in the loop 50:37 Making pricing decisions auditable 52:55 What stays defensible in 3 to 5 years 54:55 What Maverick looked for at Series A 56:46 Why Navin chose Maverick 58:17 Health plans in 3 to 5 years 1:01:55 Who captures the value 1:03:55 Best advice they didn't take

CONNECT WITH NAVIN NAGIAH LinkedIn: https://www.linkedin.com/in/navin-nagiah-8ab16

LEARN MORE ABOUT DAFFODIL HEALTH Website: https://daffodilhealth.com LinkedIn: https://www.linkedin.com/company/daffodilhealth

LEARN MORE ABOUT MAVERICK VENTURES Website: https://www.maverickventures.com LinkedIn: https://www.linkedin.com/company/maverick-ventures-sf