Certainly Health, a new patient-facing platform focused on upfront prices, has received $2.3 million in funding.
The funding was led by Pacific 8 Ventures, Y-Combinator and other institutional and angel investors. The capital will be used to expand the team and improve the platform.
Certainly claims to be the first marketplace for patients to book doctors with insurance while avoiding surprise bills, and is free for patients. They enter their insurance and the reason for their visit into the platform, which uses machine learning to predict and guarantee their out-of-pocket costs across providers.
Certainly is currently available in New York City with data for Blue Cross Blue Shield, UnitedHealth Group, Cigna and Aetna.
More than half of Americans have received a surprise bill and more than a third of Americans delay care for fear of bills. The cost of a healthcare service can also vary by hundreds of dollars across providers.
“Growing up, my parents would honestly tell me to not trust doctors because they would get these unexpected medical bills,” Kevin Chiu, Certainly co-founder and CEO, told Fierce Healthcare.
While on a journey to get a surgery himself in 2020, Chiu also couldn’t get clarity on how much he had to pay. “I started to look into and dive into this space around surprise bills and healthcare,” he said.
While he came across other marketplaces, like MDSave, Chiu couldn’t find one that showed prices upfront, taking into account health insurance. After spending nearly two years figuring out how to build a platform like Certainly, Chiu came to the conclusion that it couldn’t be done.
But in July 2022, everything changed. The Transparency in Coverage rules took effect, mandating most payers to publicly post pricing information for covered items and services—opening the door for Certainly's service.
Though the data is public, Chiu noted, often these prices will be listed on a payer portal in a large range or will not be guaranteed. That’s the appeal of Certainly to consumers, he said.
In addition, Certainly looks at claims data to offer a patient-specific predicted price for the most common medical services. It also offers a guarantee, so if patients end up owing more than the Certainly-listed price for that service, Certainly will cover the difference. If patients end up owing less, Certainly promises a refund within 24 hours.
“Our business model depends on us being accurate,” Chiu said. “Over time, … we believe we can be the most accurate platform for predicting these out-of-pocket costs.”
So far, there have been inaccuracies, Chiu acknowledged. In most cases, the inaccuracies come from incorrect assumptions about what will be covered by someone’s co-pay.
However, if a provider performs a service not listed in the search results, the patient will be on the hook for the bill. Certainly welcomes users on its site to send an email to get services added to the list.
Right now, Certainly’s focus is on in-network rates. Out-of-network rates are less available through public payer data, Chiu said, though the goal is to build that feature out more.
Certainly has provider clients, but currently also lists providers it does not have a working relationship with the hopes of eventually earning their business and providing consumers with as many options as possible.
This approach takes a page from Uber Eats’ playbook, said Chiu, who was previously a software engineer at the company. Uber Eats lists restaurants it doesn’t work with on its platform, sends them orders and then converts them into clients.
In the same way, Certainly sends providers new patients, guaranteed to always pay. Over time, Certainly will eventually only list providers who pay to be on the platform, Chiu said.
Certainly has plans to expand but is still deciding what market to pursue next, Chiu said. First, it has intentionally limited its scope, in region and payers, to improve the business before scaling.