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)
In a similar fashion: I purchased a helmet + bikeshare membership
I live in an urban environment, so I don't want to store a bike (or worry about getting it stolen). It's 1) vastly increased my footprint and appetite for checking out new areas and 2) helped me get some more exercise into my days.
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)