PokitDok: helping sick people find out cash cost for treatments

Peter Biddle sez,

Some friends of mine are up and running on a web startup called PokitDok. I'm on their tech board and the Facebook, blog and Twitter posts I did while I was dealing with my father's illness and death over the past year became part of their VC pitch materials.

Ted and Lisa and I have been talking for years about how we can use social media and math to link concentrations of organically acquired expertise in specific areas of health (eg cancer survivors or supporters, or people like me with ankylosing spondylitis, or who have had to get a loved one out of involuntary commitment...) with people who have suddenly found themselves immersed in similar situations.

Along the way to solving those problems (and I think they will!) they discovered that there are also some very immediate problems to solve - on Pokitdok they help people find out the actual cash cost for treatments with specific doctors, which in the US is extremely hard for normal people to discover because of regulations and insurance. They also let people look at alt medicine (like acupuncture) and modern medicine in the same place and context, which really is an "it's about time" social integration.

PokitDok (Thanks, Peter!)


  1. Really? Alt-medicine? As Tim Minchin says: “Alternative medicine has either not been proved to work, or been proved not to work. You know what they call alternative medicine that’s been proved to work? Medicine.”

    1. In the US, for lower back pain, it is sometimes easier to get opioids and surgery than it is to get massage or spinal manipulation.  Manipulation and massage, considered alternative by many MDs, are effective interventions for some, they don’t have the long term risks of addiction and don’t have the risks of surgery.  There are studies showing that some receive benefit with manipulation and massage.  There are no studies that show better long term results for opioids for noncancer pain.  Surgery is (in my mind) still sometimes the best solution, but it’s case by case, and some studies showing no or only mild long term benefit vs. nonsurgical treatment.  I’ve no idea if Pokitdok helps you negotiate the decision tree or not.

      1. I don’t know if this information is helpful or not, but most pain-related back-surgeries have at best, a 50% decrease in pain after surgery. I also don’t know if most neurosurgeons share the downside to this type of surgery with their patients?

      1. In my years working in one of the top ten hospitals in the US, I saw patients smeared with tar, wounds irrigated with cranberry juice, milk and molasses enemas and, of course, leeches applied to the face.

    1. Yeah, I get some parts of it, but “I have insurance but would rather pay cash”? The only thing that comes to my mind is that even if it’s not pre-existing, it can still hurt your insurance if the insurance company knows, and that’s scary.

      On the other side, what were they supposed to say? “Bringing US healthcare into early 20th century — today”?

      1. I have out of state insurance that I can basically only use for an emergency room where I am. I couldn’t even get an appointment the other day, even if I wanted to pay in cash. These things happen.

          1. Well that’s good. Urgent cares don’t usually require an appointment and the good ones could have you seen by a doctor pretty quickly. Bummer about the emergency room that is crazy expensive.

          2. Fuck urgent care.  FUCK THEM.

            The last time I had a REALLY bad infection that kept coming back, urgent care just threw some antibiotics at it instead of DRAINING IT.  Even when I TOLD them to fucking drain it.  “DRAIN THIS, RIGHT NOW!”

            “Oh, no, it’s *fine*.  Here are some antibiotics.  We won’t drain it.”

            “CAN you drain it?” I asked.

            “Oh, if we needed to!  But it’s fine!”

            The hospital took one look at me the first time, and asked why the fuck urgent care didn’t do anything, because if I had waited any longer … it probably would have gone septic.  Isn’t that nice?

            (I mean at one point I was practically *crawling on the floor* begging for help at the urgent care and they just threw vicodin and generic antibiotic scripts at me and told me to leave.  I went to the hospital and the doctor there was FLOORED. And apparently they had given me the wrong type of antibiotic. TWICE. Which is why it almost went septic.)

            The only reason I went back the second time was because I was broke and without insurance and figured it’d be cheaper, especially because I knew exactly what they needed to do.  HAHA.  I just wasted yet more money.

            Total waste of time and like $300 I didn’t have.  FUCK urgent care.

            It was a nice clinic, too!  (I also happen to live next door to a realllllly good hospital.)

            This is the shit that happens when you’re broke and go to urgent care. You get substandard care.

            Hospitals are better and easier and have far better trained staff. I am never again stepping into an urgent care. Fuck that.


    2. I agree but maybe the way the town doctor use to be was the best way before the whole ins. thing took over. With social web we could possibly see more of that dynamic come back. 

  2. So a healthcare insurance intermediary with a quirky social-networking slant?  Also, “no codes”?  Someone, somewhere is inputting ICD-10s or else this Dr. or PokitDok is not getting reimbursed.  The website says “Once you decide on the best option for you”…so am I self-diagnosing?  Or just choosing my own CPT  code from a list of treatment options?  Say I have to get my ACL rebuilt, so I shop around for a cheap Ortho and PokitDok automatically keeps track and bills out my 29888?

    So many questions.  Will PokitDok interface back to my primary care physicians EHR?  I suppose they could spit out an X-12 flat file.

    I’m nerding out a little on this just because I’ve been in Healthcare IT for most of my career and I’ve seem a lot of things come and go.  Healtheon/WebMD comes to mind.  They seem to epitomize the way most (successful?) tech companies view the heathcare system.  Get gigantic, become more expensive to replace than the value you provide, lumber on as a vampiric dinosaur milking as much cash as you can out of thing and never reinvest.

    Oops, I got a little jaded there.  This is probably why they keep me locked up in the basement and why we have things called “informaticits” now…

    1.  I don’t know you, but I love you. I too have worked with some of these health tech companies. In a way they are all trying to solve a problem, but the first problem want need to solve is “how can our investors make butt loads of money and get out”

      I’m not just a little tired of the profit motive driving so many things in our world, but I’m especially tired of it driving health care.

      Years ago I first heard of Elisabeth Warren when she did a study that showed 50 some percent of all bankruptcies in the US were because of health care costs. And for most of these people they HAD insurance. How messed up is that?

      And do I want to shop around for health care to cut costs? No. You know who should be doing that? Someone with leverage, like the government. But they cut deals with the drug makers and the insurances companies which screwed the seniors with a Dougnut Hole of Financial doom.

      So what are informaticits? I haven’t heard that term.

      1.  This, so much this.  Every year, I volunteer at a “casino night” & concert benefit to help cover expenses for families with kids that have a catastrophic medical problem like cancer or a car accident.  We bring in over $1 million on that night, plus more with an annual marathon — yet even though we have no expenses and are focused on just the parents of our little middle-class suburb, even though there’s a lot of children’s charities & such, it’s still not enough.

        (This is where I really wish there wasn’t a swearing filter.  A situation as deeply wrong as the above deserves something a little stronger than kindergarten-safe language. No offense intended to the moderators/writers.)

  3. I know little about navigating the  US insurance jungle having had no insurance most of the years in the US, so I signed onto pokitdok hoping for clear info. The site is opaque and buggy as hell. Nearly all topics so far seem to be about alternative medicine. Not helpful so far.

  4. Actually where other folks might see this as working with a system that makes the statement “I would prefer to pay cash” seem stupidly outrageous, I see it as creating a whole new system. Healthcare providers don’t advertise what services they provide or how much they cost like other industries. If PokitDok provides an avenue for providers to advertise what they charge for services maybe it could change the whole system.

    Example; A couple years back NPR did a comparison of the cost of an MRI by two companies on the same street. One charged $750 for it, the other $250 for the very same thing. What would a provider with competitive services and pricing LOSE by not adopting an Amazon-esque method of advertising?

  5. There is something about boing boing  that leads to a disproportionate number of partially processes titles coming up in my brain before i finish reading. Maybe it is because I feel comfortable reading it when I am not fully attentive or maybe it is due to the number of diverse topics…

    However “PolkaDOT: finding Cash value of sick people” was not the real headline… yet.

  6. I think this is interesting that so many people are passionate in so many ways concerning this matter from slamming a company that is actually trying to make something to comments about some person thinking that processing information is difficult in this day and age.  I can assure you the clearing houses chop off the CPT codes.  Socialized medicine doesnt mean free.  Health doesnt mean you dont have to take care of yourself.  As far as natural medicine is concerned I have had good experiences where narcotics failed.  Did you use Kayak the first time it launched? I looked at the launch date on this site and it says July 17th.  Did anyone see the wall street journal today?  Sitting back and saying things are impossible isnt really american isnt it?  Cant do this cant do that blah blah blah.  I dont have insurance because I am a 1099  by choice due to free lance type of work that I accomplish.  I would love it if there were as Val said an amazon like experience.  We need the providers bidding on the customer.    And to the comment abou the Polka dots we need more of that cause every time i search WebMD comes up and I am gonna die of cancer.  

    1. “Socialized medicine doesnt mean free.”

      No-one really thinks that, it’s just easier than saying “free at point of service” every damn time. And socialised healthcare is still by far the superior system, despite it not being literally free.

      “As far as natural medicine is concerned I have had good experiences where narcotics failed.”


  7. Turning the healthcare system transparent is not something that will happen over night. I agree that when she is asked “Do you have insurance?” and replies “Yes, but i will pay cash” is hard to understand. Being in the healthcare industry I know that if you decide to pay cash for a service you could actually get it cheaper than paying a large deductable. We have a lot of people in the country with extremely large deductables. We have an insurance system that requires us to pay a deductable basically for maintence type services. I couldn’t imagine paying Geico a deductable to pay for an oil change. With transparent pricing by doctors this will open up a whole new market where consumers actually have power in. I would love to shop for my health like anything else that is online.

    1. Yes.  Deductibles can be in the thousands, and unless people run into catastrophic problems, they don’t meet their deductible.  Also, some services require a prescription from a primary.  Sometimes that means an additional week or so delay seeing the primary, delay seeing the speicalist, and then it’s up to your primary who you get to see.   

  8. ” With PokitDok you’re able to shop for your health just like everything else”.

    I’m sure they mean well, but this is absolutely not the way to get me to look at a new HMO.

     The time to negotiate with the police union is not while you are being burgled. The time to talk fire department bond issues is not while your house is on fire. And the time to make health care choices like this is not while you are sick.

    In civilized nations, health care is not considered an opportunity to make money from vulnerable consumers. This ad doesn’t represent the solution to the problem, it represents the problem.

  9. “link concentrations of organically acquired expertise in specific areas of health…with people who have suddenly found themselves immersed in similar situations.”

    Speaking from a lot of experience with both common & very rare conditions, it’s already fairly easy to find support communities for all kinds of medical problems & difficult situations, including helping a friend/relative get an involuntary commitment rescinded. There’s even at least one site dedicated to people with just about any condition connecting with others handling the same thing.  (The one I know is Inspire. I couldn’t remember its name offhand, but it appeared as #3 with the second Bing search I tried.)

  10. PokitDok is a horrible idea. This service will not help the patient. If anybody can use this service, then guess what? So can the insurance companies. Once they see how much a service ‘generally’ costs in cash, it will create an incentive for them to raise their deductibles so that it matches or exceeds the procedure cost. Not only is this service a horrible idea for patients, it’s doing the insurance companies a HUGE favour.

    1. Not only that, but it gets worse when you look at the other end of this spectrum. PokitDok will also encourage doctors who are possibly under-qualified or under-equipped or both to offer procedures that deliberately under-cut insurance deductibles to get the cash in hand directly. Again, the patient looses with this service.

      I have to ask at this point, why is Boing Boing promoting PokitDok?

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