Launch HN: Certainly Health (YC S23) – Book doctors without surprise bills
This is the future. I also know that in-advance EOBs* happen to be on the agenda for the CMS.<p>I&#x27;m curious about how you solved a couple of problems because it&#x27;s becoming clearer to me that healthcare operates in a probabilistic way, which makes price prediction hard. Here&#x27;s a simple timeline of how an average person interacts with the healthcare system.<p>1. A patient has a symptom<p>At this point, the patient can see a primary care doctor, or see a specialist themselves.<p>2. Patient sees a doctor and receives a diagnosis<p>Depending on the symptoms and the doctor, they&#x27;ll receive a set of diagnoses with some probability.<p>3. Patient receives a treatment<p>The patient, based on their symptoms and doctor, will get some set of treatments  with some probability.<p>I guess here&#x27;s the rub with outpatient data. Even if you completely figure out the pricing problem, it&#x27;s not obvious (at least not to me) that when a patient goes in for an outpatient procedure that they&#x27;re going to be billed for exactly the shoppable service they think they&#x27;re getting, because it&#x27;s based on probabilities. I think your tool alludes to this actually -- more below.<p>A meniscus repair is an outpatient procedure, and part of CMS&#x27;s shoppable services list*. But I&#x27;m not sure that it&#x27;s the case that when you see an orthopedic surgeon for a meniscus repair that you&#x27;ll be billed for CPT code 29880, or 29881, or something else. It might depend on the surgeon and what they see when they dig into your knee. They also might X-ray your knee, which may or may not be covered.<p>(I&#x27;m not actually sure of the possibilities here, but I think David Gaines at CareIgnition (<a href="https:&#x2F;&#x2F;www.careignition.com&#x2F;" rel="nofollow noreferrer">https:&#x2F;&#x2F;www.careignition.com&#x2F;</a>) might know, if you want to discuss with him.)<p>Anyway, to test how you solved this, I searched &quot;meniscus tear&quot; in my area (zip 11377). What I saw was the rates for first consultations with orthopedic surgeons. I did not see rates for the procedure itself, so I couldn&#x27;t easily see what you do in the case that a person is shopping for a 29880&#x2F;29881. However, I did notice that the price variation for a consultation can vary up to a factor of 3, depending on whether the consultation is graded as low or high complexity. You do a good job of explaining this in the drop-down, and noting that most visits are low-complexity, but I suspect that as you expand to more outpatient procedures, the probabilistic parts will become nontrivial and more important...<p>I suppose one approach is to limit procedures in your search engine to ones where 1) the patient _knows_ exactly the procedure they&#x27;re getting and 2) there&#x27;s a low probability that they patient expects to pay for anything but that procedure. Or maybe you could say something about this? I&#x27;m genuinely curious.<p>Finally, one more comment on guaranteed pricing, which I&#x27;m sure you&#x27;ve thought about. My alarm bells go off when I see &quot;guaranteed&quot; because I know, for sure, that some of these rates are wrong. Not all, but some decent fraction of them, and it depends on the carrier -- Aetna&#x27;s rates tend to be more reliable than United&#x27;s for example. I know this because I compared them to internal contracts, and know other people who have done the same. You might be able to pressure the carrier to honor the rate that they published (and I know this has been done on the hospital side) but that&#x27;s a different story, and I&#x27;m not sure how that process shakes out. I also know that sometimes the carrier published multiple rates for the same service, without disambiguating information. I&#x27;m not sure how common this is with the subset of codes&#x2F;plans you&#x27;ve pulled.<p>* &quot;Explanation of Benefits&quot;, i.e. the bill. The insurance company would tell you, before your procedure, the patient&#x27;s portion of the bill, which parts would be denied, etc.<p>* <a href="https:&#x2F;&#x2F;www.cms.gov&#x2F;healthplan-price-transparency&#x2F;resources&#x2F;500-items-services" rel="nofollow noreferrer">https:&#x2F;&#x2F;www.cms.gov&#x2F;healthplan-price-transparency&#x2F;resources&#x2F;...</a>