> ## Documentation Index > Fetch the complete documentation index at: https://docs.arlohealth.ai/llms.txt > Use this file to discover all available pages before exploring further. # Is a named provider or facility in-network, and what do they charge for a service > Whether a specific provider or facility is in-network for the plan, and optionally what they charge for a service. Call this FIRST for any named clinic, brand, facility, or provider: the billing-entity fork (same visit, very different rates by contracting entity) only surfaces here. Anonymous limit: 20 requests per minute per IP (name search is the expensive path). ## OpenAPI ````yaml /api-reference/pricing-openapi.yaml post /api/pricing.v1/network-status openapi: 3.1.0 info: title: Arlo Health Pricing API version: 1.0.0 summary: >- US in-network cost estimates and provider network status from insurers' published rate files. No login or key required. description: >- Free, anonymous price-transparency API. Estimates come from insurers' machine-readable rate files and Medicare's fee schedules (Anthem, Blue Cross Blue Shield plans via BlueCard, Blue Shield of California, UnitedHealthcare, Cigna, Aetna, HCSC, Original Medicare) and public CMS data. Read the guide before relaying numbers to a person: https://api.arlohealth.ai/api/pricing.v1/guide.md What to get from the person, in order of impact: insurer name (required), location (for a named clinic, the clinic's city or ZIP), the exact service (age, new vs established, screening vs symptom, body part, contrast), employer or plan name from the card (turns ranges into exact rates), group number (Blue Cross Blue Shield IL/TX/OK/NM/MT only), provider name or NPI, and from a past bill or Explanation of Benefits the billing NPI and Tax ID (settles which entity bills). Three rules that apply to every response: 1. Relay `disclaimer` every time. Estimates are never guarantees, and the number is a negotiated rate, not out-of-pocket cost. 2. A named clinic, brand, or provider goes to `network-status` first. `search` is area discovery and does not resolve who bills. 3. Never quote a single number while the billing entity is unresolved (`billingOutlook.mode` = partitioned, `multiEntity` = true, or several `billingCandidates`). Data vintage: 2026-08 payer files. termsOfService: https://arlohealth.ai/tos contact: name: Arlo Health email: keaton@arlohealth.ai url: https://arlohealth.ai x-agent-guide: https://api.arlohealth.ai/api/pricing.v1/guide.md x-skill: https://api.arlohealth.ai/api/pricing.v1/skill.md x-disclaimer: >- Estimates come from the insurer's published machine-readable rate files (latest monthly data) and are not a guarantee of price. Actual billing can differ based on plan specifics, services performed, and your deductible status. Confirm cost and network status when scheduling. servers: - url: https://api.arlohealth.ai description: Production security: - {} - bearerAuth: [] tags: - name: Discovery description: >- Read these first: the guide, the contract, the service catalog, and the supported insurers. Cacheable for an hour. - name: Pricing description: >- The lookups. Anonymous calls are rate limited per IP per minute; a few are served at a time per caller. externalDocs: description: Agent guide (markdown) url: https://api.arlohealth.ai/api/pricing.v1/guide.md paths: /api/pricing.v1/network-status: post: tags: - Pricing summary: >- Is a named provider or facility in-network, and what do they charge for a service description: >- Whether a specific provider or facility is in-network for the plan, and optionally what they charge for a service. Call this FIRST for any named clinic, brand, facility, or provider: the billing-entity fork (same visit, very different rates by contracting entity) only surfaces here. Anonymous limit: 20 requests per minute per IP (name search is the expensive path). operationId: checkNetworkStatus requestBody: required: true content: application/json: schema: type: object description: >- Whether a specific provider or facility is in-network for the plan, and optionally what they charge for a service. Call this FIRST for any named clinic, brand, facility, or provider: the billing-entity fork (same visit, very different rates by contracting entity) only surfaces here. properties: providerName: type: string description: >- Provider or facility name. Consumer brand names work (matched against NPPES doing-business-as records too). City or ZIP helps disambiguate. npi: type: string description: 10-digit NPI if known. Never required. code: type: string description: >- Optional. CPT/HCPCS code from the supported catalog (GET /api/pricing.v1/catalog). There is no free-text service input: the caller selects the code, because codes carry patient facts the server cannot infer (screening vs diagnostic intent, age band, new vs established patient, body part, contrast, duration). An unknown code returns 200 with needsMoreInfo plus the full supportedServices catalog. With a code, each match carries its contracted rate under the plan. limit: type: number description: >- Max matches (default 50, max 100). Large systems bill under many NPIs whose network status and rates differ; the breadth is the signal. latitude: type: number description: Preferred when available. Pair with longitude. longitude: type: number zip: type: string description: 5-digit US ZIP when coordinates are unavailable. planHints: type: object description: >- Insurance identifiers from the patient. For anonymous calls this is the ONLY plan input: pass at least payerName (see GET /api/pricing.v1/payers for accepted names). employerName / planName upgrade range estimates to the exact plan's rates when they match a published plan; Group # is only matched for Blue Cross Blue Shield of IL/TX/OK/NM/MT (HCSC). Original Medicare needs no other identifier. Set unavailable=true when the patient cannot provide identifiers, which suppresses further asks and keeps range-based estimates. properties: payerName: type: string description: >- Insurer as the patient names it (e.g. "Anthem", "Blue Shield of California", "UnitedHealthcare", "Cigna", "Aetna", any Blue Cross Blue Shield plan, "Original Medicare"). A bare "Medicare" is priced as Original Medicare with a medicare_type ask; Medicare Advantage plans (an insurer's name next to Medicare, HMO/PPO, Part C) are declined with the reason. employerName: type: string description: >- Employer the insurance is through, as printed on the card or known to the patient. planName: type: string description: Plan name printed on the insurance card. groupNumber: type: string description: >- Group # exactly as printed on the card. Matches the exact plan for HCSC (BCBS IL/TX/OK/NM/MT) members; other payers do not publish it. unavailable: type: boolean description: >- true when the patient cannot provide plan identifiers. Stops plan asks; estimates stay range-based. patientId: type: string description: >- Family-member patient id on the caller's account. Authenticated calls only: anonymous calls that pass it receive a needsMoreInfo 'auth' ask. required: [] example: providerName: One Medical zip: '94107' code: '99213' planHints: payerName: Anthem responses: '200': description: Matches with network status, rates, and billing-entity candidates. content: application/json: schema: type: object properties: service: type: object description: >- Echo of the resolved service. VERIFY appliesTo against the actual patient before relaying any number. properties: code: type: string name: type: string category: type: string appliesTo: type: string description: >- The selection fact baked into this code (age band, new vs established, screening vs diagnostic, contrast, duration). priceNote: type: - string - 'null' description: >- Pricing semantics that change what the number means (per-unit billing, ACA preventive $0 cost-share, facility fee excludes the physician's separate bill). Relay whenever present. medicareNote: type: - string - 'null' description: >- Original Medicare responses only, on codes Medicare does not pay under this code (routine physicals, telemedicine-specific codes, anesthesia, contraceptive IUD): what Medicare covers instead and which code to use. Relay it and switch codes when it names one. relatedCodes: type: array description: >- Sibling codes selected by a different patient fact (age band, complexity, screening vs diagnostic). If one fits the patient better, re-call with it. items: type: object properties: code: type: string name: type: - string - 'null' when: type: string description: The patient fact that selects this sibling. supportedServices: type: array description: >- Full pricing catalog, returned when the service could not be resolved. Pick the right code and re-call. items: type: object properties: code: type: string name: type: string category: type: string location: type: object description: >- Whether the ZIP/coordinates passed were consumed. Only re-ask the patient for location when applied=false. properties: applied: type: boolean source: type: - string - 'null' matches: type: array items: type: object properties: npi: type: number name: type: string description: Legal billing name. entityType: type: string description: organization | individual otherNames: type: - array - 'null' items: type: string description: >- NPPES doing-business-as names (consumer brands, e.g. 'One Medical'). employers: type: - array - 'null' items: type: string description: CMS-enrolled group affiliations. address: type: - string - 'null' city: type: string state: type: string zip: type: string latitude: type: - number - 'null' longitude: type: - number - 'null' locationPrecision: type: - string - 'null' description: '''address'' | ''zip_centroid''' identityCaution: type: - string - 'null' description: >- A same-name person far from the given location. Verify it is the intended provider before relaying anything. inNetwork: type: boolean description: >- true = appears WITH negotiated rates in the plan's published network files. false = not found in the published files; read note for how strong that signal is. Never state a hard 'out of network'. networkEvidence: type: number description: >- How many of the plan's network memberships back the in-network claim. 1-2 = thin, 10+ = broad participation. note: type: string matchNote: type: - string - 'null' description: >- Present on matches appended by re-searching the name WITHIN the plan's files (fires when the regular name matches are all outside the plan). Often the system's main billing entity at another location; verify identity before relying on it. rate: type: - number - 'null' description: >- Exact-plan negotiated rate for the requested service; null on fallback matches. On Original Medicare, the approved amount. rateRange: type: - object - 'null' description: >- Spread across the payer's plan schedules when the exact plan is not matched. When wide (see note), median and typicalRate are the useful reference points. properties: min: type: number max: type: number median: type: number rateSampled: type: - boolean - 'null' rateNote: type: - string - 'null' description: >- In-network but the plan's published files carry no rate for this code. Relay; do not read a missing rate as 'not covered'. On Original Medicare it carries the facility-setting caveat or the code's medicareNote. patientShare: type: - object - 'null' description: >- Original Medicare only: what the person owes for this service at the approved amount. afterDeductible is the coinsurance once the year's Part B deductible is met; beforeDeductibleMet is the most they owe if it is not; limitingChargeMax is set only for non-participating providers (the approved amount plus 15%). 0 on screening benefits and clinical lab tests. Relay the note. properties: afterDeductible: type: number beforeDeductibleMet: type: number limitingChargeMax: type: - number - 'null' note: type: string medicareStatus: type: - object - 'null' description: >- Original Medicare only: how the network answer was derived. basis 'cms_enrollment' (the CMS clinician file; assignment 'participating' = accepts the approved amount as payment in full, 'non_participating' = may bill up to 15% more, null = not recorded) | 'observed_billing' (bills Medicare per public claims, assignment unknown) | 'opt_out' (Medicare pays nothing; private contract) | 'no_record' (not a verdict). Relay the accompanying note. properties: enrolled: type: - boolean - 'null' assignment: type: - string - 'null' description: participating | non_participating | null optedOut: type: boolean basis: type: string description: >- cms_enrollment | observed_billing | opt_out | no_record setting: type: - string - 'null' description: >- office | facility; null when no usable published rate backs the match. typicalRate: type: - number - 'null' rateAssessment: type: - string - 'null' description: >- Set when the rate is far from typical. ALWAYS relay; flags invisible markups like hospital-contract billing of routine visits. serviceEvidence: type: - string - 'null' description: >- Observed-billing evidence from public Medicare claims data: 'observed' = this NPI actually bills this service | 'category_observed' = bills near-identical services, very likely performs it | 'unconfirmed' = no billing record found. Relay serviceAvailabilityNote and advise confirming; NEVER say they don't offer it (the data misses non-Medicare practices). serviceAvailabilityNote: type: - string - 'null' description: Relay when present. billingOrg: type: - string - 'null' multiEntity: type: - boolean - 'null' billingOutlook: type: - object - 'null' description: >- Read this FIRST on a rated match. mode 'single' (one entity, quote it), 'resolved' / 'likely' (a leading entity with its evidence basis: lead with it, mention alternatives), or 'partitioned' (the price is a decision tree on WHO BILLS: relay the 'ask' in patient-answerable terms, walk the branch their answer selects, and NEVER quote one number while partitioned). A 'warning' is binding: a brand-name match does not establish the biller. properties: mode: type: string description: single | resolved | likely | partitioned ask: type: - string - 'null' warning: type: - string - 'null' partnership: type: - string - 'null' description: >- The brand's own disclosure of which entity bills, when known. leading: type: - object - 'null' basis: type: - string - 'null' billingCandidates: type: - array - 'null' description: >- The rate for this clinician grouped by CONTRACTING ENTITY (billing org TIN), cheapest first. More than one candidate means the same visit prices differently depending on which legal entity bills it. The files cannot say which entity a given booking will bill: surface the fork and resolve the entity from outside evidence (who runs the clinic, health-system partnerships, the EOB of a past visit) before quoting one number. items: type: object properties: billingOrg: type: - string - 'null' description: >- Legal/business name of the contracting entity, from the payer's files. tin: type: - string - 'null' description: The entity's tax id (billing org identity). rate: type: - number - 'null' rateRange: type: - object - 'null' description: >- Spread across the payer's plan schedules when the exact plan is not matched. When wide (see note), median and typicalRate are the useful reference points. properties: min: type: number max: type: number median: type: number rateNote: type: - string - 'null' description: Why a range is shown instead of a rate. setting: type: - string - 'null' description: >- office | facility; null when the candidate has no usable published rows. nMemberships: type: number description: >- How many of the plan's network files price this NPI under this entity. typicalRate: type: - number - 'null' rateAssessment: type: - string - 'null' description: Always relay when present. evidence: type: array items: type: object description: >- Evidence tags: observed (real adjudicated claims) | payer_credentialed (the payer's own directory, with an as-of date; nominates, never settles) | brand_disclosed | employer | brand_registration. billingCandidatesOmitted: type: - number - 'null' description: >- The candidate list was capped; this many more contracting entities exist. billingNote: type: - string - 'null' description: >- Present when billingCandidates has multiple entities. Relay it; do NOT quote a single rate without resolving the entity. signals: type: array description: >- Pre-gated evidence signals from public CMS data. Relay each signal's 'display' sentence as written; never compress into ranking or 'best doctor' language; never treat absence as negative (non-Medicare practices legitimately lack data). An 'exclusion' signal (federal OIG exclusion list) is a legal-status safety notice: always relay it plainly. items: type: object properties: type: type: string description: >- volume | outcome_context | optout | absence | exclusion hcpcs: type: string floor: type: number description: >- Volume floor: performed at least this many per year (Medicare). pctl: type: number description: >- National percentile. Present only when high (positives-only display). level: type: string description: >- 'facility' signals describe the facility, never the clinician. facility: type: string measure: type: string score: type: - number - 'null' ci: type: array items: type: - number - 'null' verdict: type: - string - 'null' denominator: type: - number - 'null' display: type: string description: >- Derivation sentence. Relay verbatim or summarize without changing meaning. required: - type - display medicareAnchor: type: - object - 'null' description: >- Medicare reference point. source 'observed' = what Medicare actually paid THIS provider; 'schedule' = Medicare's published fee-schedule rate for the provider's AREA (phrase it as the area rate). A reference point, not the patient's price and not a fair-price claim. properties: source: type: string description: observed | schedule medicareAllowed: type: number rateRatio: type: - number - 'null' description: Displayed rate divided by the Medicare amount. year: type: - number - 'null' setting: type: - string - 'null' plan: type: object description: >- What the estimate is based on. Always read matchTier and basis before relaying numbers. properties: payer: type: - string - 'null' description: >- Payer key (anthem | blueshield_ca | uhc | cigna | aetna | hcsc | medicare). null when no supported insurer could be identified (matchTier no_payer), including Medicare Advantage plans: read needsMoreInfo for what to tell the patient. payerLabel: type: - string - 'null' description: Display name for the payer. matchTier: type: string description: >- ein_exact | employer_exact | plan_name_exact | group_exact (the exact plan was found: rate is its negotiated rate) | payer_fallback_unbacked (the exact plan was found, but Arlo does not have that plan's own rate files yet: ranges only, and asking for more identifiers will not help) | payer_fallback (insurer known, plan not identified: ranges across the insurer's plans) | medicare_schedule (Original Medicare: rate is Medicare's approved amount for the provider's locality, and the top-level medicare block plus per-provider patientShare say what the person owes) | no_payer (no supported insurer) basis: type: string description: >- Human-readable explanation of what the estimate is based on. Relay it. sponsor: type: - string - 'null' description: >- Matched plan's identity string. May carry the plan-type token (HMO vs PPO) on group-keyed plans; plan type routinely flips the same hospital between in- and out-of-network, so relay it. payerSource: type: string description: >- 'hint' (planHints.payerName) or 'linked_coverage' (the authenticated patient's linked insurance records). coverageSelection: type: object description: >- Authenticated calls only. Present when linked records carry more than one active coverage row: {payor, activeRows}. Relay which coverage was used; pass planHints.payerName to pin a different one. coverageNote: type: string description: >- Present when Arlo is missing part of the matched plan's network files. Relay it: providers reachable only through those networks may be absent, and 'not found' is a weaker out-of-network signal. planHintsReceived: type: object description: >- Present when planHints were passed: {matched, matchedOn?, reason?}. matched=true only when one of the caller's hints selected the plan; matched=false means do not re-ask the patient for the same value. medicare: type: object description: >- Present on Original Medicare responses. The year's Part B deductible, coinsurance, and limiting charge, whether a Medigap supplement was mentioned, and assumed=true when the person said only "Medicare" (confirm it is not an Advantage plan; the medicare_type ask says how). Relay the note once. properties: coverage: type: string description: original assumed: type: boolean year: type: number partBDeductible: type: number coinsurancePct: type: number limitingChargePct: type: number medigap: type: boolean note: type: string rateFetchNote: type: string evidenceCardEligible: type: boolean description: >- true when exactly one match carries evidence signals (a UI may render an evidence card). signalDefinitions: type: object methodology: type: string needsMoreInfo: type: array description: >- Asks to relay to the patient. Answering them improves the estimate (ranges become the plan's exact rates). Each ask names the field, why it matters, and how to obtain it. A medicare_type ask means the numbers assume Original Medicare and the person must confirm they are not on a Medicare Advantage plan. items: type: object properties: field: type: string ask: type: string why: type: string how: type: string description: >- How to obtain it: ask the patient, read an EOB, or a public lookup (e.g. NPI registry). options: type: array items: type: string required: - field - ask disclaimer: type: string description: >- ALWAYS convey to the patient: estimates come from the insurer's published data and are not a price guarantee. headers: X-Arlo-Api-Version: schema: type: string description: Contract version (currently 1). Link: schema: type: string description: >- rel="service-doc" points at guide.md, rel="service-desc" at openapi.json. '429': description: >- Too many requests: the per-IP limit for this route was exceeded (RATE_LIMITED), or the service is busy (BUSY). Wait Retry-After seconds and try again. content: application/json: schema: type: object properties: error: type: string description: >- Machine-readable code: RATE_LIMITED | BUSY | PRICING_PUBLIC_DISABLED | NOT_FOUND | PRICING_SEARCH_FAILED | PRICING_NETWORK_STATUS_FAILED | PROVIDER_EVIDENCE_FAILED message: type: string retryAfterSeconds: type: number required: - error headers: Retry-After: schema: type: integer '503': description: Anonymous pricing is paused. Honor Retry-After. content: application/json: schema: type: object properties: error: type: string description: >- Machine-readable code: RATE_LIMITED | BUSY | PRICING_PUBLIC_DISABLED | NOT_FOUND | PRICING_SEARCH_FAILED | PRICING_NETWORK_STATUS_FAILED | PROVIDER_EVIDENCE_FAILED message: type: string retryAfterSeconds: type: number required: - error components: securitySchemes: bearerAuth: type: http scheme: bearer description: >- Optional. An Arlo account token adds linked-coverage plan matching and family-member patientId. Anonymous calls resolve the plan from planHints only. ````