Healthcare price transparency marketplace Certainly Health raises $2.3M

The 2022 Transparency in Coverage Rule required insurance companies to publish their prices

The lack of price transparency in healthcare has real consequences for both patients and doctors: 57% of Americans receive surprise medical bills and two-thirds worry about them, while 63% of providers see increases in patient balances as a challenge.

"Many doctors have told us that patients don't understand their insurance, which has been exacerbated by high deductible plans becoming more prevalent," said Kevin Chiu, co-founder and CEO of Certainly Health, a healthcare marketplace for booking medical and cosmetic care with upfront prices. The company announced a $2.3 million funding round led by Pacific 8 Ventures, Y-Combinator, and other institutional and angel investors on Wednesday.  

"Lack of price transparency also has led to huge price variance across providers with no difference in quality. This means patients have been unable to choose the best, most affordable care for them."

Certainly Health solves this by providing a marketplace to book doctors with upfront prices. Patients just have to enter their insurance and visit reason, and the company uses machine learning to predict and guarantee their out-of-pocket costs for every health provider. If patients end up owing more than the price listed when they booked through Certainly covers the difference on their behalf. For providers, the company ensures every patient it sends will always pay the entire patient responsibility.

"By allowing consumers to use their health insurance as usual, we can avoid significant consumer education or changes to provider workflows. And since even insured prices can vary by hundreds of dollars across providers with no difference in quality, we still help consumers save money without sacrificing quality of care," Chiu explained. 

The company was unlocked by the 2022 Transparency in Coverage Rule that required insurance companies to publish all their prices for the first time. Using that data, it launched in New York City with thousands of doctors available to book.

On the patient side, the typical customer is in their 20s or 30s, has previously received surprise bills, and is looking to book care that can be scheduled in advance. The most common booking is to see a dermatologist for an annual skin screening, and Certainly has had bookings for cosmetic procedures like Botox, which are not covered by insurance but also have significant price variance.

Overall, the company ha had patients book 10 different specialties, including podiatry, ENT, and PCP.

"We've helped numerous patients avoid surprise bills and save money. One patient booked a podiatrist saved $900 compared to a previous visit with a different podiatrist for the same services. We've also helped several other patients get refunds on visits where they were overcharged," Chiu said.

The new capital will be used to expand the team at Certainly Health, growing it from just the two co-founders, adding around seven employees total over the next year or so, as well as to improve the company’s product. That mean expanding to enable more consumers to book with guaranteed out-of-pocket costs for more types of care, including radiology, labs, as well as more cosmetic procedures.

"The goal of Certainly Health is to become the go-to place for people to book care while saving money and avoiding surprise bills. Success is empowering Americans to have a full picture of cost to make informed decisions on their healthcare as often as possible," said Chiu.