This Startup Wants To Take The Mystery Out Of Your Medical Bill


Just got my bill from my doctor’s visit for a knee
injury. Got charged $356 but I have to pay $0. Health I
nsurance stuff is cool lol

— Lo Trinidad (@ArloTrin)

ID: 9217914

I felt totally confident when my doctor took 12 vials of
blood since I have insurance and now I’m looking at a
$750 bill. 😨

— amber (@AmbBoothman)

ID: 9217920

For a hearing test, you and your insurance company together
could pay on average $168 in San Francisco, $259 an hour south
in San Mateo, or $105 in Los Angeles.

Why so complex? Each hospital or doctor’s office has a list of
charges for different procedures, and when each insurance
company gets billed, it negotiates for discounted prices with
each provider. Those lowered prices can vary even more
depending on the kind of plan that you, the patient, have.

Amino has data for 49 procedures and services, from ACL
surgeries to vasectomies, in all 50 states, and for 129
insurance carriers, including UnitedHealthcare, Aetna, and
Cigna. They’re based on more than 800 million insurance claims
for 188 million patients, totaling $860 billion — the prices
that insurers negotiated for the given procedures — from June
2015 to April 2016. (The hearing test prices mentioned above
come from Amino.)

“What we’re launching is the ability for people to know before
they go to the doctor’s office, not when they get the bill
afterward,” CEO David Vivero told BuzzFeed News.

Amino launched in October with a search engine that lets you
find doctors in your area and book appointments through the
site. This new feature lets you price-shop on top of that.

Here’s a range of costs for a pap smear in Fremont,
California. Note this is what Amino calls the network
rate
— the total of what you and your insurance carrier
would pay.

Here's a range of costs for a pap smear in Fremont, California. Note this is what Amino calls the network rate — the total of what you and your insurance carrier would pay.

View this image ›

Via amino.com

ID: 9217977

For a better idea of what your out-of-pocket costs might
be, you’d plug in a few more pieces of information.

For a better idea of what your out-of-pocket costs might be, you'd plug in a few more pieces of information.

View this image ›

Via amino.com

ID: 9217989

If you don’t have insurance, Amino can still give you an
estimated price range for procedures, but the range will be
wider because it encompasses all private insurers in the given
region. You also can’t search for Medicare or Medicaid.

Amino doesn’t cover every possible cost and situation. It only
covers procedures offered at doctor’s offices — not outside
facilities, including hospitals, where the cost factors are
often more numerous and complex. So Amino can’t give you an
estimate for an MRI or childbirth, for example. In addition,
you may have complications during a procedure, or your
treatment may change midway through.

“This is not a guarantee of what the price is going to be. What
it is, is an estimate,” Vivero said. “And so the types of
decision you can make are, maybe you go across town to a
different doctor for your colonoscopy if there’s a substantial
difference. Maybe you wait because you have so much in your
deductible that you should wait until next year. Or maybe you
get it done a little bit earlier.”

Many states have adopted legislation that require providers or
payers to publicly report information about pricing and
quality. One example is this
website from the California Department of Insurance, which
launched last fall.

Still, laws don’t guarantee all that information is easy to
find and understand. Every year, the nonprofit Health Care
Incentives Improvement Institute scores states’ health care
transparency-related legislation and how well they’re being put
into place.
Its latest report card, based on 2014 data, gave an “A” to
just one state — New Hampshire — and an “F” to 45 others.

Employers have also started to offer online price-transparency
tools. But a May
study of two large employers found that few workers
actually used the tools, nor did they spend less on health-care
costs as a result.

Every data set has its strengths and weaknesses. On the
California Department of Insurance’s website, a search for the
rough cost of a pap smear — the same search done on Amino’s
website — requires you to first search under umbrella
categories like “chronic conditions, maintenance and
preventative care” and “reproductive and urinary systems.” (The
closest selection, which appears to be “cervical cancer
screening,” is in the latter category.) To figure out how your
insurance comes into play, you have to click away to your
carrier’s website.

What sets Amino apart, Vivero says, is its emphasis on
packaging all this data in an “extremely consumer-centric” way.
“We think everyone has the right to know this information,” he
said.



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