Medical Bill Gurus

What Medical Bill Gurus does

Medical Bill Gurus is a privately-held, independent medical billing and patient advocacy services firm headquartered in Houston, Texas. Founded circa 2003, the company operates with 11-50 employees across four U.S. offices (Houston, Denver, St. Petersburg, Scottsdale) and serves customers nationwide. Its two interlinked service lines are patient-facing advocacy — helping individuals recover out-of-network insurance reimbursements, with a stated specialty in integrative and alternative treatments such as ozone therapy, stem cells, and IV infusions — and provider-facing revenue cycle management, covering coding, claim submission, denials management, and underpayment recovery for medical practices of all specialties. The firm holds self-attested HIPAA compliance with documented administrative, physical, and technical safeguards for protected health information.

The offering is structured as a services-based practice spanning nine documented modules: Patient Advocacy, Provider Billing, Out-of-Network Claims, Coding & Submission, Denials Management, Underpayment Recovery, Retrospective Revenue Recovery, PA Reimbursement Optimization, and Integrative Care Billing. No proprietary technology platform, APIs, mobile applications, or software products are disclosed in available sources — the technical stack is unspecified — and 20+ years of reimbursement experience is positioned as the company's primary asset. Specialist billing staff handle coding decisions, claim submission, and persistent payer follow-up rather than automated engines.

Revenue is generated primarily through a contingency model: Medical Bill Gurus invoices 25% of successfully recovered insurance reimbursements, with no fee charged if no recovery is achieved (a deposit exception applies to BCBS policies, and recovered checks are issued directly to the policyholder). Go-to-market relies on a content-driven blog, a dedicated 1-800 consultation line, free case evaluations, and website lead forms, reaching both direct-to-consumer patient leads and direct-to-provider B2B accounts. The firm is independently owned and operated, with no disclosed venture capital, private equity, parent entity, or funding rounds.

Name

Medical Bill Gurus

Legal name

Medical Bill Gurus LLC

Website

https://medicalbillgurus.com

Company type

Private

Founded year

2003

Operating status

Operating

Headcount range

11–50 employees

Short description

Medical Bill Gurus is a Houston-based medical billing and patient advocacy firm that helps patients recover out-of-network insurance reimbursations and delivers revenue cycle management to healthcare providers on a 25% contingency fee basis.

Ownership category

akta.pro rank

Product category

Healthcare Revenue Cycle Management

NAICS

Accounting, Tax Preparation, Bookkeeping, and Payroll Services (5412)

SIC

Services-Health Services (8000), Hospital & Medical Service Plans (6324)

akta.pro primary industry

Patient Billing, Statements & Payment Processing (HLACACAG)

akta.pro secondary industries

Claims Management, Scrubbing & Clearinghouse (HLACACAB), Medical Coding, Billing & Clinical Documentation Support (BPAAAFAD), Healthcare Billing & Patient Payments Presentment (FSAMAJAH)

Keywords

• Medical billing services
• Patient advocacy
• Revenue cycle management
• Out-of-network claims
• Insurance reimbursement

Headquarters

HQ city

Denver

HQ country

United States

HQ region

North America

Offices4 records

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

Personnel, Operations, Marketing or Sales, Technology or R&D, Infrastructure

Revenue model

1. Contingency-based Patient Advocacy Services: The company operates on a 25% contingency basis. When successful in securing insurance reimbursement for patients, they invoice 25% of the recovered funds. If no recovery is achieved, no fee is charged (excluding deposit for BCBS policies). This aligns incentives and removes financial risk for patients.

Pricing tiers

Go-to-market motion1 record

Distribution channels2 records

Marketing channels3 records

Core offering

Medical Bill Gurus is a third-party medical billing, coding and patient advocacy service. For patients, it reviews medical bills, builds custom reimbursement strategies and pursues out-of-network insurance claims on a 25% contingency basis (no fee unless funds are recovered). For healthcare providers, it delivers turnkey revenue cycle management including coding, claim submission, denials management, underpayment recovery and out-of-network claim preparation, with sub-specializations in integrative/alternative treatment billing, retrospective revenue recovery and physician assistant reimbursement.

Product overview

Medical Bill Gurus operates as a patient advocacy and medical billing services company offering three interconnected core service lines: Patient Advocacy (bill review, claim strategy, and insurance follow-up for patients), Provider Billing (turnkey revenue cycle management for medical practices), and Out-of-Network Claims specialization. The offering is structured as a services-based platform rather than software products, with sub-modules including Coding & Submission, Denials Management, Underpayment Recovery, Retrospective Revenue Recovery, PA Reimbursement optimization, and Integrative Care Billing. All patient services operate on a 25% contingency basis with no fee if no recovery is achieved.

Differentiator

Problem solved

Functional benefit

Products and services

• Patient Advocacy Review of patient medical bills to identify reimbursable line items, custom reimbursement strategy development, claim submission and persistent follow-up with insurance companies on behalf of patients. Billed on a 25% contingency basis — no fee if no recovery is achieved.
• Provider Billing (Revenue Cycle Management) Turnkey revenue cycle management for medical practices covering coding, claim submission, denials management, underpayment recovery and out-of-network claim preparation performed by billing specialists.
• Out-of-Network Claims Specialized patient-side service helping individuals self-submit and recover reimbursements for treatment received from out-of-network and integrative providers, including itemized superbills, claim forms and follow-up with insurers.
• Retrospective Revenue Recovery Systematic review of historical claims to identify and pursue underpayments, omissions and errors for revenue recovery on previously processed claims.
• Physician Assistant Reimbursement Strategic billing models for physician assistant services, including 'incident to' billing guidance and reimbursement maximization strategies for practices.
• Integrative Care Billing Identification of reimbursable FDA-approved components within alternative treatment bills (ozone therapy, stem cells, IV infusions) including doctor consultations, lab tests and medical supplies, for both patients and providers.

Segments2 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Scale indicators2 records

Recent moves6 records

Expansion highlights5 records

Emerging players

• AKASA: AKASA applies AI automation to revenue cycle workflows including claims status, denials, and appeals for hospital systems and large practices. It operates in the same RCM operations category as MBG's Provider Billing but focuses on automation for large enterprises.
• Candid Health: Candid Health is an emerging RCM platform purpose-built for digital health and specialty provider groups, with automated claims and denial workflows. It addresses the same outsourced RCM category as MBG's Provider Billing, but with a software-first, venture-funded model.

Direct peers

• CoPatient: CoPatient is a patient-facing medical bill advocacy and negotiation service that helps consumers review, dispute, and reduce erroneous charges. It directly competes with Medical Bill Gurus' Patient Advocacy and OON Claims service lines for the same out-of-pocket patient segment.
• Resolve: Resolve negotiates and reduces medical bills on behalf of consumers, including out-of-network and surprise-billing cases. It competes head-on with MBG's patient advocacy offering on a contingent or savings-based model.
• Goodbill: Goodbill is a patient bill negotiation platform that audits medical bills and reduces overcharges, often leveraging AI-assisted line-item review. It targets the same patient bill-help category as MBG's advocacy services, with a similar contingency-style savings-based model.
• BillFixers: BillFixers negotiates medical and dental bills on behalf of consumers, primarily through phone-based advocacy. It directly overlaps with MBG's patient advocacy services and shares a similar conversational, contingency-driven acquisition model.

Broad incumbents

• R1 RCM: R1 RCM is one of the largest outsourced healthcare revenue cycle management companies in the U.S., serving hospitals and large provider systems. It competes with MBG's Provider Billing/RCM offering at the enterprise scale and significantly broader portfolio of services.
• Waystar: Waystar is a leading healthcare revenue cycle management software platform covering claims management, denials, and patient payments. It overlaps with MBG's Coding & Submission, Denials Management, and patient payment processing offerings as a software incumbent rather than service provider.
• Athenahealth: Athenahealth provides practice management and EHR-integrated revenue cycle management for medical practices of all sizes. Its RCM module overlaps with MBG's Provider Billing services for ambulatory practices.
• Experian Health: Experian Health provides patient access, identity management, and revenue cycle management solutions to providers and payers. It overlaps with MBG's patient billing, eligibility, and claims workflows at the enterprise software level.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat3 records

Key risks6 records

Key highlights6 records

Customer concentration

• Xx.com/MedBillGuru
• Facebookfacebook.com/medicalbillgurus

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Medical Bill Gurus