Waynesville startup targets medical bill chaos
The numbers arrive without warning, often weeks after the crisis has passed, stamped in clinical language and coded in ways few patients understand — turning moments of vulnerability into prolonged financial strain.
“My first feeling was a very big thud in my stomach to get a big bill like that and not at all expect it. And then the second feeling was like, what the hell?” said Kasha Williamson. “A little bit of anger, I would say.”
Across Western North Carolina and beyond, patients facing high deductibles or those with no coverage at all are discovering that the hardest part of a medical emergency may not be the diagnosis or the treatment, but the opaque billing systems that follow.
For self-employed residents in their 50s, like Kasha and her husband Kelly, those bills can feel less like a statement of services and more like an unsolvable puzzle. After receiving two separate hospital bills last year, the couple found themselves immersed in a labyrinth of billing codes, classifications and pricing discrepancies.
“I thought, well, I can resolve this problem just simply by calling the number on the bill and getting this taken care of, because I’m the customer and all I have to do is call to get this taken care of,” Kelly said. “When I did that, I was given the runaround and then the frustration sets in, because the process is not easy to actually work through — getting the bill figured out and getting it resolved.”
One bill, labeled as an emergency room Level 4 visit, appeared inconsistent with the care received. Another, tied to a routine mammogram and follow up, raised similar questions. What should have been straightforward medical encounters instead triggered weeks of research into “current procedural terminology” codes and federal billing regulations.
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Their experience exposed a gap between what patients are charged and what they are equipped to understand. That gap, often widened by time constraints and financial pressure, leaves many people paying bills they can not fully comprehend, let alone challenge.
Frustration led to exploration for the Williamsons. Existing medical bill negotiation services offered help but at a cost that mirrored the very problem they aimed to solve, taking 20% to 30% of any savings secured. For patients already struggling to pay their bills, that model offered little relief.
Out of that frustration came an idea rooted in both necessity and practicality. Rather than outsourcing the fight, the couple began exploring whether the tools already reshaping other industries could be adapted to empower patients directly.
What followed was months of intensive development. Drawing on a background in IT and engineering, Kelly began testing multiple artificial intelligence platforms, including large language models, to analyze medical bills. The goal was not simply to interpret charges but to identify inconsistencies, flag potential errors and guide users through the process of disputing questionable costs.
The process proved more complicated than expected. Medical billing is governed by layers of coding systems and regulatory frameworks, each interacting in ways that even professionals struggle to navigate. Early experiments made clear that no single AI system could reliably handle that complexity on its own. Instead, the solution emerged as a hybrid approach. By combining multiple AI tools with databases of benchmark pricing and coding rules, the couple developed a system designed to replicate the kind of detailed review typically performed by billing specialists.
The result is FairMedBill, a home-based startup in Waynesville offering a flat-fee service aimed at making bill analysis accessible to ordinary patients. For a modest cost, users can upload multiple bills and receive a structured review that highlights potential errors and provides guidance on how to challenge them.
Customer information is protected by HIPAA laws, is never seen by human eyes and is not retained once the review is complete.
The concept reflects a broader shift in how consumers now interact with healthcare systems. As insurance coverage becomes less predictable and out-of-pocket costs rise, patients are increasingly forced into roles once reserved for industry insiders, acting as their own advocates in disputes over pricing and classification.
For many, that role is overwhelming. FairMedBill is designed to break that cycle, offering users a starting point rather than a final answer.
“There are a several different types of errors that can occur,” Kelly said.
One category involves straightforward clerical or arithmetic mistakes. Pure math errors are relatively uncommon because much of that process is automated, but they can still happen.
Clerical issues are more frequent and tend to arise during the multi-step billing process. After a patient visit, a physician records notes, which are then interpreted by a coder who converts them into standardized billing codes. From there, the billing department assigns charges based on those codes. Because this process involves interpretation at multiple stages, inaccuracies can occur — such as selecting the wrong code, failing to use the most appropriate code for the situation or choosing a code that results in higher charges than warranted.
“Then there’s things that aren’t exactly errors,” Kelly said. “They’re actually what we call ‘systemic billing practices.’”
One such practice is called unbundling — basically, charging a là carte prices for services or supplies that should all be part of one treatment or procedure.
“That’s not allowed, basically,” Kasha said. “In all those procedures, there’s already sets of rules around that. Sometimes it’s a mistake, and sometimes it’s systemic.”
The tool does not promise automatic reductions or guaranteed outcomes. Instead, it focuses on equipping patients with information, helping them understand what they were charged and why, and identifying areas where those charges may not align with standard practices.
That distinction is central to the company’s approach. While some consumers may assume that artificial intelligence can instantly resolve billing disputes, the reality is more nuanced. Effective challenges still require human involvement, persistence and, in many cases, direct communication with providers or insurers.
The platform aims to streamline that process, reducing the time required to identify issues and organize a response.
The timing of the launch reflects a growing need. As policy changes and market shifts alter the landscape of health coverage, more individuals find themselves underinsured or uninsured, facing higher deductibles and greater exposure to unexpected costs. In that environment, tools that enable patients to question and verify charges take on increased significance.
At the same time, the rise of artificial intelligence has created new possibilities for analyzing complex data sets. By leveraging those capabilities, FairMedBill represents an attempt to translate technological advances into practical benefits for consumers, particularly those who lack the resources to hire professional negotiators.
The early results, while limited, have been encouraging for the founders. Personal use of the system led to significant savings on their own bills, and initial testing with a relative produced similar outcomes. Those experiences suggest that, when applied correctly, detailed analysis can uncover discrepancies that might otherwise go unnoticed.
Still, the company remains in its early stages, with broader adoption and long-term impact yet to be determined and a patent on the technology currently pending. Questions remain about scalability, accuracy and the extent to which users will be able to translate insights into successful disputes.
Those uncertainties highlight the challenges inherent in any effort to disrupt established systems. Medical billing practices are deeply embedded in the healthcare industry. Changing how patients interact with those systems will require not only new tools, but also shifts in behavior and expectations.
For now, the focus remains on accessibility. By offering a low-cost entry point, the platform seeks to reach individuals who might otherwise forgo any attempt to review their bills. In doing so, it positions itself as both a practical resource and a form of consumer advocacy.
“People are already dealing with medical debt. Why would we want to then make the situation worse? This is really a passion project,” Kasha said. “From our perspective, we’re not looking to Silicon Valley, we’re not looking to cash out. This is really out of a feeling of wanting to be able to help people who are in a bad situation.”
The broader implications extend beyond individual savings. Increased scrutiny of medical bills has the potential to influence provider practices, encouraging greater transparency and accountability. While a single tool is unlikely to reshape the system on its own, it may contribute to a gradual shift in how billing is perceived and contested.
In Western North Carolina, where small businesses and self-employed residents make up a significant portion of the population, those changes carry a particular weight. Financial resilience often depends on the ability to manage unexpected expenses, and medical bills remain one of the most unpredictable variables.
By framing billing review as a do-it-yourself process supported by technology, FairMedBill aligns with a wider trend toward consumer empowerment. Whether that approach will gain traction on a larger scale remains to be seen, but it reflects a growing recognition that patients need more than information — they need tools that make that information usable. For the Williamsons, that’s what success looks like.
“It’s just knowing that people use it,” Kelly said. “It’ll be good just knowing that people use and get some savings out of it.”
For more information, visit fairmedbill.com .
