Know what every patient owes — before they’re in the chair
Carelyze reads your treatment-plan PDF, pulls the patient’s real coverage from the carrier portal, and returns a line-item estimate of what insurance pays and what the patient owes — accurate at the moment before service, before any claim is submitted.
Jane D.
DOB May 25, 1996 · Dental PPO · Visit May 13, 2026
Patient pays
$580.50
est. out-of-pocket · 4 procedures
| Procedure | Fee | Ins. | Patient |
|---|---|---|---|
Tooth 14 — Crown — porcelain/ceramic D2740 | $935.00 | $392.50 | $542.50 |
Tooth 14 — Core buildup D2950 | $144.00 | $115.20 | $28.80 |
Tooth 14 — Indirect pulp cap D3120 | $46.00 | $36.80 | $9.20 |
| Total | $1,125.00 | $544.50 | $580.50 |
How this number was calculated
D2740 · allowed = min($935, $835) = $835.00
major category · plan pays 50%
Coverage pulled live
from the carrier portal · 0m ago
Why Carelyze
Accuracy at the moment before service
Carelyze does the insurance verification your front desk does by hand today — faster, and thorough where your EHR’s estimate is sloppy.
Real coverage, pulled live
We log into the carrier’s own provider portal with your credentials — handling MFA automatically — and read the same eligibility, benefits, and history the carrier shows you. Not a generic database. Not a guess.
Catches what the EHR skips
The checks manual estimates miss — and the difference your clinic eats weeks later, or the patient gets as a surprise bill.
Every dollar shows its work
Open any line to see the exact rule waterfall and the carrier field behind the number. The AI organizes coverage; it never invents a price. Low-confidence estimates are flagged for review before they reach a patient.
Before & after
The manual workday, replaced
Insurance verification is one of the most time-consuming jobs at the front desk. Carelyze does the same work — without the portal grind or the missed rules.
- Pull tomorrow’s appointments from the EHR
- Log into each carrier portal, one patient at a time
- Transcribe deductible used, max remaining, coverage %, and history
- Cross-reference every code against the fee schedule
- Hand-compute the patient’s out-of-pocket
- Present it at check-in — and hope nothing was missed
- Upload the treatment-plan PDF you already export
- Carrier login, MFA, and the coverage pull are handled for you
- Estimates ready by morning — each with a confidence score and rule trace
- Re-run in seconds at the chair when the plan or member ID changes
- Every dollar traces back to a rule and a carrier field
- Low-confidence estimates are flagged for review, never shown blind
How it works
Three steps to a patient’s real number
The same three stages run inside the product, in plain language — from the PDF you already have to a number you can trust.
Reading the treatment plan
Upload the treatment plan
Drop in the treatment-plan PDF you already export from your EHR — or type the procedures by hand. Carelyze reads the CDT codes, teeth, and billed fees automatically.
Checking insurance coverage
We check the patient’s coverage
We log into the carrier’s provider portal with your stored credentials, clear MFA automatically, and pull real-time eligibility, benefits, maximums, and treatment history — with a live activity log you can watch.
Calculating the estimate
Get the patient’s cost estimate
A line-item estimate of what insurance pays vs. what the patient owes — with deductible drawdown, annual-max impact, watch-out flags, a confidence score, and the rule trace behind every dollar. Numbers based on synthetic coverage are never shown.
Estimates are ready overnight for tomorrow’s schedule — and re-run in seconds at check-in when the plan or member ID changes.
Built to be trusted
Verifiable trust, not a black box
These numbers get shown to patients. So every estimate is built to be checked — by your staff, and by us.
Explainable
Every dollar traces to a specific rule and the exact carrier field behind it. No black box.
Confidence-scored
Uncertain estimates are flagged and routed to a staff review queue — never shown to a patient blind.
Cross-checked
Compared against your EHR’s own estimate, surfacing any disagreement instead of hiding it.
Real coverage or nothing
Numbers based on synthetic or unverified coverage are never shown. If we can’t confirm it, we don’t state it.
Where it’s heading
One thing done very well — then the rest of the clinic’s insurance work
We start with the highest-stakes moment: the patient-cost estimate before service. The same engine is built to take on more of the back office over time.
See Carelyze run on your next day’s appointments
We’ll run real estimates against a sample of your upcoming visits and compare them to your own EHR numbers — so you can see the accuracy before you commit. Questions about onboarding, pricing, or HIPAA? We’re happy to walk through it.
Visit Us
333 West San Carlos Street
San Jose, CA 95110