DeskGate
BAA active · Vertex AI · 28 Sep 2026
Healthcare Credit Rail · For lenders and capital partners
Patients finance care at checkout. Weeks later, a health plan denies part of the claim and the provider bills the patient again, on top of the loan. Almost nobody appeals. DeskGate stages the appeal at the provider's desk in about two minutes, so payer cash settles the bill instead of your borrower.
How it works
Your loan is approved before the health plan has decided anything. When the plan says no, the bill doesn't disappear. It moves to the same patient who is already repaying you.
The patient finances their expected share. The provider bills the health plan for the rest.
The plan denies all or part of the claim. Missing or inaccurate data is the leading cause providers report5.
The provider bills the patient for the denied amount. Your borrower now carries a second balance next to your loan.
A coordinator stages the appeal from quoted chart facts and clicks Submit. If the plan pays, the second bill goes away, or the payment is refunded to the patient's financing account.
When appeals are filed, many succeed. In Medicare Advantage, 80.7% of appealed prior-authorization denials were overturned2. In marketplace plans, insurers upheld 56% of the few appeals filed1. The claims nobody appeals are the ones that are certainly lost.
Illustrative case
A $5,000 procedure. The patient finances a $1,500 share. The plan denies $2,000 of its $3,500.
Without an appeal, the patient owes $1,500 to the lender and $2,000 to the provider, at the same time. With a successful appeal, the provider is paid by the plan and the patient is back to one payment: yours.
Illustrative numbers, not data. Measured figures come from the one-desk pilot described below.
Exposure
The effect on your book depends on what was financed and when. Two of the three are direct: a recovered claim lowers the principal itself.
A denial creates a second bill next to your loan. Recovering it removes that bill, which lowers strain on the borrower.
Some practices collect the full fee upfront and refund the patient when the plan pays. A denial means that refund never comes. Recovering it triggers the refund to the patient's financing account.
Health systems and physician groups enroll whatever the plan didn't pay into a patient payment plan. Every unappealed denial becomes enrolled principal. Recovering it shrinks that principal.
Fit by lending segment
DeskGate only helps where a health plan was supposed to pay. If your book is mostly cash-pay care, there is no claim to recover.
| Lending segment | Where insurance comes in | Fit |
|---|---|---|
| Post-service payment plans | Plans run with health systems and physician groups finance what is left after insurance, so every unappealed denial is enrolled as patient principal. | Strongest |
| Dental financing | Most patients carry dental benefits, and claims are routinely denied, downgraded or capped by annual maximums. At Synchrony, which runs CareCredit, dental accounts made up 49% of Health & Wellness interest and fees in 20253. | Strong |
| Medical specialty and surgical financing | Procedures pass through prior authorization and medical-necessity review on portals DeskGate already stages, including Availity and UHC. | Strong |
| Fertility financing | Coverage depends on state mandates and employer benefits. Where a plan covers treatment, its denials can be appealed. | Partial |
| Cosmetic, medspa, LASIK, veterinary | Cash-pay care with no health-plan claim behind the loan. | No fit |
Why lenders care
The CFPB found that borrowers were charged deferred interest on 20% of healthcare deferred-interest purchases from 2015 to 2020, and on about 34% for credit scores below 6194. A surprise second bill is one more strain on the same borrowers.
A borrower who never receives a surprise rebill for a denied claim has one obligation to meet: yours.
Measured, lower loss rates on provider cohorts that recover denials support tighter spreads on warehouse credit facilities.
The CFPB has raised concern about patients being put on medical credit when insurance or financial assistance should have covered the care4. A documented appeal shows the plan was asked to pay before the patient.
What we don't claim yet: DeskGate has no measured lender loss data. Default, reserve and spread effects are the thesis. The pilot below is how the numbers get produced, on your own provider network.
Pilot
You nominate one provider in your network for one of the first 10 free-month desks. Both sides read the same ledger on day 30.
Pick a provider with steady insurance-billed volume. Their practice manager or billing director signs off. No IT steering committee.
Before day 1 we record appeals completed per coordinator-day. One named seat, one portal family, about 20 minutes to deploy.
On day 30 the Schedule M ledger shows throughput against the baseline. The provider's payer remittances show what was paid.
The blinded ledger records desk code, host domain, handling minutes and a SHA-256 reference hash. No ePHI is stored in DeskGate databases, and none is shared with the lender.
DeskGate drafts from quoted chart facts and writes [MISS] where the chart is silent. The coordinator reviews every field and clicks Submit. Screen reads run on Google Cloud Vertex AI under DeskGate's BAA, executed 28 Sep 2026.
Next step
Tell us what you finance and through how many providers. We'll come back with the provider profile that gives you the clearest 30-day read.
Sources
1 KFF, Claims Denials and Appeals in ACA Marketplace Plans in 2023, January 2025, updated March 2026. HealthCare.gov insurers denied 20% of in-network claims; fewer than 1% of denied claims were appealed; insurers upheld 56% of appeals.
2 KFF, Medicare Advantage Insurers Made Nearly 53 Million Prior Authorization Determinations in 2024, January 2026. 11.5% of denials were appealed, and 80.7% of appeals overturned the initial denial.
3 Synchrony Financial, Form 10-K for fiscal 2025. Health & Wellness, which includes CareCredit, reported $15.7 billion in purchase volume across more than 290,000 locations; dental accounted for 49% of its interest and fees on loans.
4 Consumer Financial Protection Bureau, Medical Credit Cards and Financing Plans, May 2023.
5 Experian Health, State of Claims 2025, September 2025. 41% of providers face denial rates of 10% or higher; missing or inaccurate data was the leading cause cited (50%).