Care Pricing Tools - Arlo Health

Overview

Two read-only tools answer the questions patients can’t answer themselves at booking time: “what will this cost me?” and “is this provider in my network?”

Tool	Question it answers
`search_care_prices`	Where can I get a service nearby, and what does each place charge under my plan?
`check_network_status`	Is this specific provider or facility in-network for me — and what do they charge?

Both are free to use: they never charge the user, never start a consultation, and work without an active care request. Estimates come from insurers’ published machine-readable rate files (public price-transparency data), matched to the patient’s plan via their connected insurance when available.

Coverage — US only. Supported payers today: Anthem Blue Cross (CA/NY), Blue Shield of California, UnitedHealthcare (including UMR, Oxford, and Surest), Cigna, and Aetna.

Estimates are never guarantees. Every response carries a disclaimer — always relay it: actual billing can differ based on plan specifics, services performed, and deductible status, so the user should confirm cost and network status when scheduling.

How plan matching works

The service resolves the patient’s plan from their linked insurance records when connected. The response’s plan block tells you what the estimate is based on:

Field	Meaning
`matchTier`	`ein_exact` \| `employer_exact` \| `plan_name_exact` \| `payer_fallback` \| `no_payer` — how precisely the plan was matched
`basis`	Human-readable explanation of what the estimate is based on
`planHintsReceived`	Present when you passed `planHints`: `{matched, reason?}` — when `matched: false`, don’t re-ask the user for the same value

When the exact plan isn’t matched, results carry a rateRange ({min, max, median} across the payer’s plan schedules) instead of an exact rate, and the response includes needsMoreInfo — asks to relay to the user (e.g. the employer or plan name from their insurance card) that upgrade results to their plan’s exact rates. Each ask includes how to obtain it. If the user can’t provide plan identifiers, re-call with planHints.unavailable: true to stop the asks and keep range-based estimates.

search_care_prices

Find nearby in-network care options with estimated negotiated prices under the user’s plan.

Parameters

Parameter	Type	Required	Description
`code`	string	No	Preferred — explicit CPT/HCPCS code from the supported catalog (the live tool description lists it)
`service`	string	No	Plain-language fallback — only exact catalog names/synonyms resolve (`"office visit"`, `"knee MRI"`); anything fuzzy returns `supportedServices` to pick from and re-call
`latitude` / `longitude`	number	No	Preferred location
`zip`	string	No	5-digit ZIP if coordinates unavailable
`radiusKm`	number	No	Search radius in km (default 40)
`limit`	number	No	Max results (default 25)
`planHints`	object	No	`employerName`, `planName`, `payerName`, `unavailable` — extra plan identifiers when `needsMoreInfo` asked for them
`patientId`	string	No	Family-member patient id from `get_user_profile` (defaults to the account holder)

The service catalog

Roughly 150 common outpatient services are supported: office/telehealth/preventive visits, psychotherapy, imaging (X-ray/CT/MRI/ultrasound, screening and diagnostic mammograms, DEXA), cardiac tests (EKG/echo/stress test), common labs and STI tests, PT/chiro, and common procedures (colonoscopy, endoscopy, injections, biopsies, IUD, vasectomy, home sleep study, spirometry, hearing test).

Passing an explicit code is preferred — the agent has the conversation context to pick correctly (screening vs diagnostic intent, age bands, body part).
When a code isn’t supported or the service text doesn’t resolve, the response returns the full supportedServices catalog — pick the closest code and re-call.
The response echoes what was priced in service — always verify it matches the user’s intent before relaying numbers (never quote a screening code for a diagnostic indication). inputConflict is set when your service text and code disagreed.

Reading the results

Results are grouped into facilities — places of care (billing NPIs grouped by street address), sorted by best rate. Present results place-first (facility name or address), with the providers inside. Each provider carries:

Field	Meaning
`rate`	Exact-plan negotiated rate; `null` on fallback matches (use `rateRange` then)
`typicalRate`	Median in-network rate for this service among this payer’s members
`rateAssessment`	Set when the rate is far from typical (≥1.75x or ≤0.4x) — always relay
`serviceEvidence`	`observed` = this NPI actually bills this service (public Medicare claims data) \| `category_observed` = bills near-identical services \| `unconfirmed` = no billing record — advise confirming; never say they don’t offer it
`note`	Per-provider caveat (e.g. a facility-billed imaging rate excludes the physician’s separate professional fee) — relay when present
`telehealthEligible`	Whether virtual delivery is plausible for this service
`confidence`	`high` \| `medium`

service.priceNote carries pricing semantics that change what the number means (per-15-minute therapy units, ACA preventive care usually $0 out-of-pocket) — always relay when present; the raw number alone would mislead. Facility latitude/longitude plus locationPrecision (address = map-grade pin, zip_centroid = approximate area) support map rendering.

A contracted rate proves the code is in that provider’s network contract — not that the service is bookable there. Advise confirming availability when scheduling.

check_network_status

Check whether a specific provider or facility is in-network for the user’s plan, and optionally what they charge for a specific service.

Parameters

Parameter	Type	Required	Description
`providerName`	string	No	Provider or facility name — consumer brand names work (matched against NPPES “doing business as” records)
`npi`	string	No	Optional NPI if known — never required
`code` / `service`	string	No	Add a service to get each match’s contracted rate benchmarked against the typical rate
`latitude` / `longitude` / `zip`	—	No	Location to disambiguate — the response’s `location.applied` tells you whether it was consumed
`limit`	number	No	Max matches (default 50, max 100). Large systems bill under many NPIs whose network status and rates differ — the breadth is the signal
`planHints`	object	No	Same shape as `search_care_prices`
`patientId`	string	No	Defaults to the account holder

Interpreting network status

inNetwork: true — the provider appears with negotiated rates in the plan’s published network files. Strong signal. networkEvidence counts how many of the plan’s network memberships back the claim (1–2 = thin, 10+ = broad participation).
inNetwork: false — “not found in the published files”: likely out of network, but files can lag reality. Advise verifying with the provider; never state a hard “they are out of network”.
rateNote — present when in-network but the published files carry no rate for the code. Relay it; don’t read a missing rate as “not covered”.

”How much does this practice cost me?”

Confirm the user’s current city/ZIP first — the same consumer brand (e.g. One Medical) bills under different legal entities in different markets, at very different rates.
If a brand name doesn’t match, needsMoreInfo tells you how to resolve it (e.g. find the billing name on an EOB, or web-search the practice’s public NPI and re-call with npi).
rateAssessment flags rates far from the payer’s typical (e.g. a routine visit billed at 4x typical under a hospital’s faculty-practice contract). Relay it — this is exactly the invisible markup patients can’t see at booking.
Rated matches carry serviceEvidence: observed means you can say they perform it; unconfirmed means phrase it as “their contract prices X at $Y” and advise confirming availability.

Example flow

// "Is One Medical in my network, and what's an office visit there?"
const result = await checkNetworkStatus({
  providerName: "One Medical",
  service: "office visit",
  zip: "94110"
});

// Relay needsMoreInfo asks, rateAssessment flags, and the disclaimer.
// If the user can't provide plan identifiers:
const fallback = await checkNetworkStatus({
  providerName: "One Medical",
  service: "office visit",
  zip: "94110",
  planHints: { unavailable: true }
});

​Overview

​How plan matching works

​search_care_prices

​Parameters

​The service catalog

​Reading the results

​check_network_status

​Parameters

​Interpreting network status

​”How much does this practice cost me?”

​Example flow

Overview

How plan matching works

search_care_prices

Parameters

The service catalog

Reading the results

check_network_status

Parameters

Interpreting network status

”How much does this practice cost me?”

Example flow