Unreasonably Deep Podcast - Episode 2: Denials, with Ayo Omojola, Co-Founder of Substrate

A doctor sees a patient, delivers the care, and does everything right. Then the payer says no. Ayo Omojola calls that the most unfair thing in healthcare, and it is the reason Substrate exists. In Episode 2, he goes deep on denials: why payers say no, what it quietly costs providers, and how AI agents are starting to change the fight.

Ayo starts by mapping the whole revenue cycle into four jobs, financial clearance, first-pass payment, AR follow-up and denials, and reconciliation, and explains why denials is the one Substrate obsesses over. It is the surface where all the friction shows up, after the work is already done. He breaks the denial fight into its real steps: knowing a denial even happened, researching why, figuring out the fix, and tracking it all the way to paid.

Then he gets specific about the money. Where it goes: cost, working capital, and the bad debt and underpayments practices quietly write off. Why small claim denials get abandoned one by one, and why, for the first time, a practice can afford to touch 100% of its claims. He also demystifies the payer side: the difference between a rejection and a denial, the big buckets of why claims get denied (eligibility, medical necessity, and administrative rules like bundling and duplicates), and the delay tactics that look less like a no and more like a bet that you will give up. The records request that lands three weeks later. The prior auth the payer approved and then would not match to the claim. The down-code that pays you for a level 3 when you delivered a level 5.

Finally, how Substrate solves it. Ayo runs the more, faster, cheaper case with real numbers: thousands of claim statuses cleared in hours, one client's cost per claim status cut from about 75 cents to under 15, and a "just give us a login" model that skips the IT project entirely. He is also straight about the boundary: what Substrate does not do, where a human still has to win the fight, and how the system gets smarter with every claim it works.

In this episode:

• The revenue cycle in four jobs, and why denials is the hardest
• Why not getting paid after delivering care is "offensive"
• The real steps to work a denial: awareness, research, remediation, follow-up
• Where the money actually goes: cost, working capital, and write-offs
• Why small claim denials get abandoned, and why you can now work all of them
• What an "AI agent" actually is, in plain terms
• Rejection vs. denial, and the big buckets of why payers say no
• Payer friction and delay tactics: mailed letters, prior-auth mismatches, records requests, down-coding
• Why a growing backlog can't be fixed by just hiring
• More, faster, cheaper: thousands of claims in hours, and 75 cents down to under 15
• "Just give us a login": getting live without an IT project
• The honest boundary: what Substrate does not do, and where humans still win
• How the system gets smarter with every claim

New here? Start with Episode 1 for Ayo's background and how Substrate came to be.