[alexanderdou]

I work in the space (specifically, on the Payer/Health Insurance Co side) and this is my current bugaboo

From best I can gather, there are a handful of High-Level issues. But for the sake of brevity, I'll highlight what I think is the biggest:

The data requisite to make a confident estimate lives in many different parties' databases. To make an estimate, you would need: (1) Full List of Procedures and Services to be done (keywords here: CPT and ICD codes); (2) Contracted Rates between Payer and Provider; (3) Patient's Deductible, OOP Max, and Plan Benefits; (4) List of which services require Pre-auth

(1) lives with the Provider

(3) and (4) live with the Payer

(2) lives in between, but is also a huge problem because it's a many-to-many sort of relationship (many Payers have many contracts (e.g. annually re-negotiated contracts) with many Providers)