5 ms·

Thanks for your comment. We handle the connections to the insurance companies and the EDI to JSON transformation. I respect your point about 5 cents being high

Thanks for your comment. We handle the connections to the insurance companies and the EDI to JSON transformation. I respect your point about 5 cents being high. We, of course, will evaluate that as time goes on. To start, you as a developer can make an app for the medical industry that checks patient's health insurance eligibility. Details you can call include: health spending accounts, deductibles remaining, coinsurance/copayment, whether or not they have coverage for MRI, etc.

samstave 14y ago
While I think this is awesome (I work in the healthcare space - on the infrastructure side (design, build and implement systems for new hospitals)) though I would LOVE to see the following, if this API allows: I as a user would like to tell you my insurance info and tell you what procedure I want and you tell me the best/cheapest location to get that done. Then - here is where the groupon model farking failed: (I have only ever bought one groupon, and I never used it, but the model for groupon should be applied to things people NEED); I want to see coupons for medical, eye, dental procedures - things I dont buy too often and when I do, I want the best deal possible. So, for example, I want teeth whitening. Or a full eye exam... etc.. Actually - there was a rockhealth company that was doing something similar, that was in the first batch, but they were LA only and hadn't quite built out the right system... /rant...
- dfc 14y ago
  Insurance covers teeth whitening? I thought elective/cosmetic procedures were not covered.
  - emmapersky 14y ago
    Each insurance is different. And each companies plans within them are different. Anything is possible if someone is willing to pay.
  - samstave 14y ago
    Not all do - but this is why I ask - I would like to see an API that lets me search for procedures I want, and ultimately have a market that makes the providers of that service compete for MY business. As it stands, the insurance market is inverted that it makes the insured compete for coverage.
    - kategleason 14y ago
      Agreed. Castlight health is doing this for employees of certain companies http://www.castlighthealth.com/ http://www.castlighthealth.com/.
- aamar 14y ago
  I as a user would like to tell you my insurance info and tell you what procedure I want and you tell me the best/cheapest location to get that done. This is offered by Castlight Health (www.castlighthealth.com), where I used to work. Though it is currently only sold to employers & offered free to their employees. Re the groupon model: I think you'd need to adjust the model a lot to sell services which are frequently covered by insurance. Teeth whitening generally isn't insured, which is why it is in fact a very frequent groupon offer.
obituary_latte 14y ago
Maybe I'm misunderstanding, but this post makes it sound like you've created an efficient API to find whether or not a person can "afford" treatment. Again, maybe (hopefully) I've misunderstood. And not to be the the tree-hugging idealist of the post, but as a fellow human, how does this make life better for the rest of us? Sorry if I seem confrontational about the whole thing; progress usually is a good thing. That said, I hate seeing great intelligence spent wholly on the bottom line. I'm also aware that I very likely am in the wrong forest barking up the wrong tree...
- briguy 14y ago
  API's and services like this are Key in making it so that more people will be able to afford medical care. Solving the current cluster F* of paperwork and time involved in establishing eligibility is one of the lowest hanging fruits in cutting medical costs (....NOTE: As opposed to more complicated cost cutting concepts such as preventative care) A typical Doctors office of 2 or 3 practitioners may have 2 or 3 or more support people spending their day faxing back EOB's to insurance companies, etc. Those dollars directly affect the cost of Health Care. This is Great.....X12 is arcane, good riddance. There are actually some insurance clearinghouses that will pay you to use them (if you have high enough volume) as they are paid by the insurance companies and/or through government incentive programs.
  - obituary_latte 14y ago
    So if I'm understanding correctly, the lowest hanging fruit to providing medical care to those in need is...paperwork? Sounds like we're working on a band-aide, not a solution. Again, progress is progress. I guess I wonder whether or not these efforts could be focused on the root. I'm probably sounding like a pretentious douche with all the answers...it's not intentional. On a very base level, I cant help but wonder what all this potential could achieve if the focus weren't money. As I understand it, the benefits you proclaim would be a side effect of a successful (read: profitable) implementation. As always, I might be misunderstanding.
    - 14y ago
joering2 14y ago
> Thanks for your comment. Perhaps I am having a bad day, but is it really necessary to thank someone for their question? Seriously, this makes me feel like I am dumb for asking a question. I understand you trying to be extra polite, but I am sure you won't start a conversation with "thank you" every time your wife, son, daughter, lover or employee ask you a question. So while many will appreciate your "politeness throw-up" attitude, personally you just caused my red flag to pop up, because I honestly feel your politeness is fake. > I respect your point about 5 cents being high. We, of course, will evaluate that as time goes on. His, and everyone else who ever paid for API and knows what is reasonable price what's not. To me this "We, of course, will evaluate that as time goes on." stripped out of bullshit means this "We will try to make fortune (or something like 100,000% profit margin on those simple text requests to our server) and will benchmark traffic, and if we don't get enough suckers to sign up, then we, of course will lower our price". I can bet you $50 that after the initial wave of HN interest, your value versus cost ratio will scare 99% of those who need to use service similar to yours. Please don't forget to post a news where you go down to a reasonable rates, like 1,000 hits for 1 cent (Sendgrid, MailChimp, etc, etc).
- rdegges 14y ago
  This seems pretty harsh. As someone who is running my own API company in an industry filled with red tape and regulations, I can fully understand a high price, especially when getting started. Often times (at least in my industry--telephony), it is nearly impossible to negotiate low prices yourself without significant volume to afford better contracts. I'm certain that everyone running an API company wants their prices to be as low as possible for their consumers, and it seems to me that your comment is really just attacking the guy unnecessarily.
- buss 14y ago
  It's one of the cheapest eligibility APIs I've seen. And the clear value add is JSON. There are some providers that do eligibility checking for free for big payers (I think Availity does) but then you have to process the mess that is X12. Trust me when I say that you want to stay as far as possible from dealing with X12 files. Other providers charge up to 20 cents per inquiry and still return X12 response. 5 cents and JSON make this highly competitive.
nitrogen 14y ago
So it sounds like this is not just eligibility to purchase insurance, but also (or instead) coverage by current insurance. Is my understanding correct?
- kategleason 14y ago
  Yes it is to check healthcare eligibility for a patient's current insurance plan. If that plan went inactive we will be able to pass you the plan end date as well.
foxhop 14y ago
I think .05 cents per request is too expensive. If generating a response is a computationally intensive task, then I understand. But your current pricing model reminds me of the pay-per-minute phone calls of yester-year. Pricing has to make sense. Pulling from my experience building and marketing LinkPeek.com, I have found the best results by providing different tiers or plans for different target markets. I try to use the different tiers to show value for different types of customers. It should be a no-brainer for your customers which plan to choose. I feel you should review your current pricing model so that you don't scare people off when they do the math.

samstave 14y ago

While I think this is awesome (I work in the healthcare space - on the infrastructure side (design, build and implement systems for new hospitals)) though I would LOVE to see the following, if this API allows: I as a user would like to tell you my insurance info and tell you what procedure I want and you tell me the best/cheapest location to get that done. Then - here is where the groupon model farking failed: (I have only ever bought one groupon, and I never used it, but the model for groupon should be applied to things people NEED); I want to see coupons for medical, eye, dental procedures - things I dont buy too often and when I do, I want the best deal possible. So, for example, I want teeth whitening. Or a full eye exam... etc.. Actually - there was a rockhealth company that was doing something similar, that was in the first batch, but they were LA only and hadn't quite built out the right system... /rant...

dfc 14y ago
Insurance covers teeth whitening? I thought elective/cosmetic procedures were not covered.
- emmapersky 14y ago
  Each insurance is different. And each companies plans within them are different. Anything is possible if someone is willing to pay.
- samstave 14y ago
  Not all do - but this is why I ask - I would like to see an API that lets me search for procedures I want, and ultimately have a market that makes the providers of that service compete for MY business. As it stands, the insurance market is inverted that it makes the insured compete for coverage.
  - kategleason 14y ago
    Agreed. Castlight health is doing this for employees of certain companies http://www.castlighthealth.com/ http://www.castlighthealth.com/.
aamar 14y ago
I as a user would like to tell you my insurance info and tell you what procedure I want and you tell me the best/cheapest location to get that done. This is offered by Castlight Health (www.castlighthealth.com), where I used to work. Though it is currently only sold to employers & offered free to their employees. Re the groupon model: I think you'd need to adjust the model a lot to sell services which are frequently covered by insurance. Teeth whitening generally isn't insured, which is why it is in fact a very frequent groupon offer.

obituary_latte 14y ago

Maybe I'm misunderstanding, but this post makes it sound like you've created an efficient API to find whether or not a person can "afford" treatment. Again, maybe (hopefully) I've misunderstood. And not to be the the tree-hugging idealist of the post, but as a fellow human, how does this make life better for the rest of us? Sorry if I seem confrontational about the whole thing; progress usually is a good thing. That said, I hate seeing great intelligence spent wholly on the bottom line. I'm also aware that I very likely am in the wrong forest barking up the wrong tree...

briguy 14y ago
API's and services like this are Key in making it so that more people will be able to afford medical care. Solving the current cluster F* of paperwork and time involved in establishing eligibility is one of the lowest hanging fruits in cutting medical costs (....NOTE: As opposed to more complicated cost cutting concepts such as preventative care) A typical Doctors office of 2 or 3 practitioners may have 2 or 3 or more support people spending their day faxing back EOB's to insurance companies, etc. Those dollars directly affect the cost of Health Care. This is Great.....X12 is arcane, good riddance. There are actually some insurance clearinghouses that will pay you to use them (if you have high enough volume) as they are paid by the insurance companies and/or through government incentive programs.
- obituary_latte 14y ago
  So if I'm understanding correctly, the lowest hanging fruit to providing medical care to those in need is...paperwork? Sounds like we're working on a band-aide, not a solution. Again, progress is progress. I guess I wonder whether or not these efforts could be focused on the root. I'm probably sounding like a pretentious douche with all the answers...it's not intentional. On a very base level, I cant help but wonder what all this potential could achieve if the focus weren't money. As I understand it, the benefits you proclaim would be a side effect of a successful (read: profitable) implementation. As always, I might be misunderstanding.
  - 14y ago

joering2 14y ago

> Thanks for your comment. Perhaps I am having a bad day, but is it really necessary to thank someone for their question? Seriously, this makes me feel like I am dumb for asking a question. I understand you trying to be extra polite, but I am sure you won't start a conversation with "thank you" every time your wife, son, daughter, lover or employee ask you a question. So while many will appreciate your "politeness throw-up" attitude, personally you just caused my red flag to pop up, because I honestly feel your politeness is fake. > I respect your point about 5 cents being high. We, of course, will evaluate that as time goes on. His, and everyone else who ever paid for API and knows what is reasonable price what's not. To me this "We, of course, will evaluate that as time goes on." stripped out of bullshit means this "We will try to make fortune (or something like 100,000% profit margin on those simple text requests to our server) and will benchmark traffic, and if we don't get enough suckers to sign up, then we, of course will lower our price". I can bet you $50 that after the initial wave of HN interest, your value versus cost ratio will scare 99% of those who need to use service similar to yours. Please don't forget to post a news where you go down to a reasonable rates, like 1,000 hits for 1 cent (Sendgrid, MailChimp, etc, etc).

rdegges 14y ago
This seems pretty harsh. As someone who is running my own API company in an industry filled with red tape and regulations, I can fully understand a high price, especially when getting started. Often times (at least in my industry--telephony), it is nearly impossible to negotiate low prices yourself without significant volume to afford better contracts. I'm certain that everyone running an API company wants their prices to be as low as possible for their consumers, and it seems to me that your comment is really just attacking the guy unnecessarily.
buss 14y ago
It's one of the cheapest eligibility APIs I've seen. And the clear value add is JSON. There are some providers that do eligibility checking for free for big payers (I think Availity does) but then you have to process the mess that is X12. Trust me when I say that you want to stay as far as possible from dealing with X12 files. Other providers charge up to 20 cents per inquiry and still return X12 response. 5 cents and JSON make this highly competitive.

nitrogen 14y ago

So it sounds like this is not just eligibility to purchase insurance, but also (or instead) coverage by current insurance. Is my understanding correct?

kategleason 14y ago
Yes it is to check healthcare eligibility for a patient's current insurance plan. If that plan went inactive we will be able to pass you the plan end date as well.

foxhop 14y ago

I think .05 cents per request is too expensive. If generating a response is a computationally intensive task, then I understand. But your current pricing model reminds me of the pay-per-minute phone calls of yester-year. Pricing has to make sense. Pulling from my experience building and marketing LinkPeek.com, I have found the best results by providing different tiers or plans for different target markets. I try to use the different tiers to show value for different types of customers. It should be a no-brainer for your customers which plan to choose. I feel you should review your current pricing model so that you don't scare people off when they do the math.