What’s up with the name? A ‘dolt’ is a stupid person, at least in the English language.

Thanks! You're doing awesome work, I read the blog post about the insurance data mess you're working through.

I'll see if I can incorporate that into my project!

I'd love to see what this map looks like filtered for specific services.

We should compel these companies to comply.

There should be fine a 1% of annual revenue for every day these companies are in non compliance with prison for the ceo if they are non compliant for over thirty days.

This could have been much much easier if they just required the medical equivalent of certificate transparency. Every insurance company is required to post publicly every single claim they receive, the full information of the provider(s), the name/code of the plan, the billing codes, whether it was approved or denied, how much the insurance was billed, and how much insurance actually paid (where paid doesn't mean discount, it means the literal dollars that left the insurance company's bank account), and the "patient responsibility" along with where the patient was with regards to their deductible and oopm. Every medical provider is required to do the same every time they create a bill.

Fine, "you don't know" how much things will cost. We can figure it out for you. No thoughts, head empty, just post and sign every bill you generate as it comes.

This paragraph is missing the link at the end:

At DoltHub, where we build databases like codebases, we're running a data bounty, collecting rates for popular medical procedures for all US hospitals. Then we'll release the data under CC. Find out more here.

Let’s do wrist x-ray and keep it simple. I’m sure I’ll mess up the formatting here.

When you get an x-ray, you would expect to see 3 claims (again, simplifying).

—— One is the x-ray tech taking the picture. That gets a professional claim with a CPT code and is straightforward.

—- One is the interpretation by a radiologist of the imaging. That is a professional claim with a CPT and a modifier.

—- The last depends on the place of service. If it’s in a hospital, or at an outpatient facility, or at an ASC, then you get a facility claim to go with it.

Next, under what circumstances did the x-ray occur? Was it during an inpatient stay? If so, the payor might pay based on a DRG, which is basically a bundle of all the services that occur during the stay. How do you decide how much of the cost to allocate to the various parts of the x-ray? There are more variations on this.

Next, how are the providers contracted? Are they participating providers? Par vs non-par have different payment rates.

Next, was the service in-network or out-of-network, defined by the patient’s insurance benefits?

Does the patient’s PCP participate in a capitated arrangement (fixed fee to the PCP’s office per month)? If so, what is the allocated cost for the service based on the submitted encounter?

What about fees for network rental? Sorry, this one is esoteric, but it’s another factor.

And so forth and so on. It’s a mess.