1. Good luck finding a startup, especially a VC-backed one (which for this kind of market I would expect is a borderline necessity), that isn't going to charge

1. Good luck finding a startup, especially a VC-backed one (which for this kind of market I would expect is a borderline necessity), that isn't going to charge at least this much if not more per transaction. 2. Would their customer be the insurer or the doctor? If it's the doctor, I can't see insurers wanting to reimburse anyone other than the doctor. If it's the insurer, why would they farm out their billing to this third party when they already have the capability, and it's clearly lucrative? 3. Medicine in general is ripe for disruption, but it's so heavily regulated that eats into a lot of the potential profits from any service provider. Everything is an enterprise contract negotiation and the technical talent leaves pretty quickly when they see how slow everything moves. I've worked with large hospital systems that were still running Windows 7. Recently.