Clinic Price Check has built a service to see if patients can save money by paying cash for procedures

Before launching Clinic Price Check, Joanne Rodrigues-Craig had been a stay-at-home mom with Master’s degrees in population demographics, political science and applied mathematics from UC Berkeley and the London School of Economics.

She’d written a book on demographics and politics, published work on data analysis for predictive customer insights and, most recently, worked for Sony as a statistics manager. But when her daughter was sick with the flu and a trip to urgent care left Rodrigues-Craig with an $800 hospital bill, she found her entrepreneurial mission — figuring out why health care expenses were so high for some people who paid with insurance when the cash cost could be much lower.

The push was a follow-up call to the hospital where the family received care, where Rodrigues-Craig was informed that the family’s bill for their care could have been 30% lower if they’d just paid cash.

That revelation sent Clinic Price Check’s founder down a data science rabbit hole where she discovered that the disparities between cash pay prices and payments through insurers can differ wildly.

“Different payer groups pay vastly different amounts for the same services,” said Rodrigues-Clark. The solo founder spent a couple of years building out a database with exhaustive pricing for medical but as the product became more developed and the implications of the work — that this could save U.S. patients hundreds of dollars on medical payments — became more apparent Rodrigues-Clark enlisted friends and family to help.

That help included Rodrigues-Clark’s cousin, Neveena Ferrao who serves as the company’s chief design officer and who built out the front-end user experience for the company’s website. It also included Rodrigues-Clark’s father, Lawrence Rodrigues, a former GE Healthcare product developer who serves as the company’s chief technology officer.

Rounding out the team is Sohini Sircar, a college friend of Rodrigues-Clark’s from Georgetown who worked as a management consultant and health care policy expert with IBM Watson’s health care team and serves as the company’s chief policy officer.

Together, the team has developed a data platform that lets patients search and find pricing information for medical services at nearby providers. The service can predict health care costs based on symptoms, diagnosis and geography.

The company’s website has been live for over a year, but the technology has taken on increased relevance in the age of COVID-19.

Just look at the case of Dr. Zachary Sussman, a physician who worked for a network of urgent care facilities in Texas under the banner of Physicians Premier ER. Dr. Sussman went to his own clinic to get an antibody test — a test that he knew cost roughly $8. His insurance provider was billed nearly $11,000 for the test and its administration. The provider of the test is now under investigation.

Currently, Clinic Price Check covers prices for around 3,500 of the over 5,000 hospitals that dot the United States and offers price comparison information for the 50 most commonly used services those facilities offer. Eventually, the company would like to cover all hospitals and urgent care facilities and provide pricing information on every service.

The company is also launching a financial assistance application for California, which would automatically determine if a patient could qualify for financial assistance at about 90% of California’s hospitals.

However, even armed with the information around potential savings, many of the medical procedures that the company provides information about are out of reach for many Americans, who don’t even have emergency funding to cover a month of rent if faced with financial hardship.

And much of the company’s business would disappear if America instituted a universal healthcare plan. “We would love to be replaced if the government capped health care prices,” said Rodrigues-Clark. “It doesn’t seem likely that that’s going to happen. In the meantime, we want to increase price transparency to push costs down toward market rates.”

So the company is building out even more services, including a price comparison tool that Rodrigues-Clark hopes she can sell to businesses. That tool would allow employees to compare their negotiated rates with cash rates and opt out of paying negotiated rates under insurance plans where it makes sense to do that, Rodrigues-Clark said.

“I built this business because there is a problem in health care,” Rodrigues-Clark said. “If the government were to cap rates that would be the best thing for American consumers … If that means there’s no longer a business here, I’m okay with that.”