Or is the regulatory framework waaaaay too favored towards incumbents to even fight?
This shit is beyond frustrating. Healthcare could actually be semi reasonable if prices were as transparent as other industries.
It isn't something that software can fix.
But under our current system, this could not be further from the case.
With the amount of money at stake, I’d imagine organizations and politicians would bury any startup before you say “Seed round”.
Ultimately this is a technological solution to a political problem. It's going to be difficult to implement and face a lot of pushback from the entrenched incumbents.
"Unfortunately this transfusion cannot be given to you because there is a mismatch between its version and the versions approved in your database record. Please contact a representative or call our support line"
To my knowledge, at many orgs, insurance is actually funded directly by the employer; they do not contribute to a massive general pool along with other orgs. That individual employer helps set rates and coverage for their individual plan, and they might hire a big payer (insurance company) like Blue Cross Blue Shield to administer the plan that they created. This means that every single employer might have different payment rules and rates for a given procedure or item, and rates can also be hospital dependent or provider dependent. Additionally, many insurance companies require pre-approval (prior authorization AKA prior auth) for more expensive procedures or procedures / meds that are being prescribed outside of normal practice. This requires the provider (doctor) to call the payer (insurance provider), explain the situation, and see if a certain procedure will be covered. Before this is done, it is impossible to quote a price. Finally, we also have a class of people without insurance.
So can real time price quotes be done? Maybe, but it would be a lot of work. The big payers do have API endpoints you can hit to get coverage information for a given user and I believe pricing data for a given procedure for that user. There are also clearing houses of sorts which can help you route traffic to the right endpoint. You would still need to get pricing data from hospitals which largely aren't interconnected for users without insurance and also deal with the prior auth situation.