Certainly Health guarantees upfront care prices | EBA

As employers scramble to mitigate healthcare costs, employees are left to pay for increasingly alarming medical bills. But unlike any other big purchase, Americans often don’t know what their care will cost them. 

Certainly Health, a New York City marketplace for medical and cosmetic care, is taking a step towards fixing that. Using Transparency in Coverage data (which is data from insurers that show the cost of covered services), Certainly Health created a search engine for consumers in NYC who are insured by Blue Cross Blue Shield, UnitedHealth Group, Cigna and Aetna.

After entering their insurance and choosing what care they need, Certainly Health shows how much that service will cost for a host of relevant providers. If the marketplace underestimates the cost, the platform takes responsibility. 

“After you enter your insurance, [Certainly] will pull in your benefits, including your remaining out-of-pocket costs, your remaining deductible, and combine that with the insurer’s negotiated rates to generate a price,” says Kevin Chiu, co-founder and CEO of Certainly Health. “If your insurance says you owe more, we cover the difference on behalf of the patient. That’s what gives you the certainty that the prices you see are meaningful.”

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Notably, the platform is free for consumers. Meanwhile, Certainly Health charges providers a fee for every patient who visits them after using the site. For Chiu, it’s a win-win for all parties: Consumers have easy access to transparent care prices, and providers are rewarded for their transparency. 

Like many Americans, Chiu has received his fair share of medical bills with unexpected costs. In fact, according to Morning Consult, 20% of Americans reported that they or their family received a surprise medical bill in 2022 alone — 22% of this group were charged over $1,000. 

“My parents would honestly tell me not to trust doctors because they would get these unexpected medical bills,” says Chiu. “As an adult, I had a couple of procedures and saw firsthand how hard it was to get clarity on what I was expected to pay. It made me realize that the problem isn’t really the doctor but the lack of transparency in the U.S. healthcare system.”

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Ultimately, Chiu wants to take the platform further, making it so a consumer could search by medical problem and get a breakdown of what possible procedures or treatments providers may suggest and the corresponding prices. For example, if a consumer had a wart, Certainly could show them what might be the most cost-effective option, be it medication or freezing it.

Given that Americans collectively owe at least $220 billion in medical debt — despite 90% having insurance — it’s obvious that no one solution can fix things. But Chiu is hopeful that tools like Certainly Health can at least give consumers some degree of agency and savings.

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“I won’t pretend to say that this will solve the issue of rising healthcare costs, but it can make a difference,” he says. “Saving $100 here or $500 here is definitely meaningful to a lot of Americans.”