Why Is It So Hard to Get Paid in Healthcare? Dr. Roja Garimella on Contracts, Payments, and AI
Guest Episode 01: Dr. Roja Garimella of Kubera Health joins Noah Vandal and Dr. Joseph Yoon to discuss healthcare contracts, payments, and AI.
By Noah Vandal and Dr. Joseph Yoon, 2026-09-30
Dr. Roja Garimella, founder and CEO of Kubera Health, joins our first guest episode to explain why healthcare payments are so difficult to trace. The conversation follows contracts, claims, and payment errors, then turns to the role of AI and the patients behind the paperwork.
A guest conversation about the work beneath every payment
Why is it so difficult to explain what a healthcare claim should pay? In Guest Episode 01 of the AI and Healthcare Podcast, Noah Vandal and Dr. Joseph Yoon welcome Dr. Roja Garimella, founder and CEO of Kubera Health, to explore that question.
Recorded July 15, 2026, the conversation runs approximately 37 minutes, 20 seconds. These notes follow the final revised episode. Roja brings experience as a physician, inside health plans, and as a founder building tools for healthcare payments.
The discussion starts with an administrative problem, but repeatedly returns to a human one: the patient or family trying to understand what care will cost.
Contracts are the starting point for understanding a claim
Roja describes payment terms spread across contracts, amendments, fee schedules, and policies. A team may know what it received without having an easy way to calculate what it should have received for each service.
Her examples include organizations estimating expected revenue from past payments and teams trying to reconcile complicated arrangements in spreadsheets. Dr. Yoon connects this to his own experience running a practice, where a batch payment could be difficult to match back to individual billed services.
In Roja's account, the challenge begins before collections. The underlying agreement must be understood well enough to calculate an expected payment and explain that calculation.
An auditable payment connects the result to its source
Roja describes Kubera's goal as an auditable contract layer: a structured record of the terms that govern payment, connected to the claims and payments those terms produce.
The useful questions become concrete:
- Which contract and amendment apply to this service?
- What rate or rule determines the expected payment?
- How does the actual payment compare?
- Can someone trace the difference back to its source?
In the interview, Roja distinguishes under-billing from underpayment. A provider might miss something it could bill under its contract, or receive less than expected after submitting a claim. Those are different problems to investigate.
She also describes grouping similar discrepancies so teams can address a recurring issue together. That changes the work from repeatedly investigating isolated claims to understanding a pattern.
AI helps with the documents, while review remains part of the work
At about 26 minutes, the conversation turns directly to AI. Roja describes using large language models to process lengthy policy documents and provider manuals. Rules help clean and organize inconsistent data, and repeatable workflows help classify problems across claims.
She also describes auditing layers over the AI output. The value of an answer depends on whether it can be checked against the source information and used in a real payment workflow.
This is a concrete companion to our discussion of evaluating healthcare AI: define the task, examine how an error will be found, and understand what a person does with the result. The episode presents Roja's account of Kubera's approach; it is not an independent performance evaluation of the platform.
Value-based care needs information people can reconcile
Roja argues that the administration around value-based care can make its goals difficult to realize. She discusses delayed payments, reconciliation spreadsheets that are hard to review, and the challenge of allocating responsibility across primary care, hospitals, and specialists.
These are observations from her work and the conversation, rather than a claim that every arrangement operates the same way. Her broader point is that a payment model needs usable information and workable reconciliation processes alongside its intended incentives.
Our earlier episode on US healthcare costs provides more context for the administrative burden surrounding care.
The person behind the claim is the reason to improve the system
Late in the episode, Roja recalls caring for a patient whose fear of the bill affected their willingness to stay in the hospital. She connects the technical work of understanding contracts to the possibility of making financial information clearer for patients.
The conversation closes with her decision to leave clinical medicine and build. She encourages clinicians and aspiring founders to test ideas, seek feedback, and act on problems they understand firsthand.
A clearer payment system is the aspiration running through the interview: one where providers, health plans, and ultimately patients can better understand what happened and why. Learn more about Roja's work at Kubera Health.
Common questions
Who is the guest in this episode?
Dr. Roja Garimella, MD, MBA, is the founder and CEO of Kubera Health. She joins hosts Noah Vandal and Dr. Joseph Yoon to discuss healthcare payments and her path from clinical medicine to entrepreneurship.
What does an auditable healthcare payment mean in this conversation?
Roja describes being able to trace a payment back to the contract terms, fee schedules, and policies that explain what should have been paid. The goal is a clear basis for checking a claim and investigating a difference.
How does AI fit into the work Roja describes?
Roja discusses using language models to read complex documents, alongside rules and repeatable workflows to structure information and investigate payment differences. She also describes auditing layers over AI output.
Is this part of the regular numbered podcast series?
This is Guest Episode 01, a separate guest conversation with Dr. Roja Garimella. Noah Vandal and Dr. Joseph Yoon remain the hosts.