Last updated: September 13, 2026 · Draft pending legal review
These Terms of Service ("Terms") govern your use of CareCost Estimate, an informational decision-support tool for healthcare providers ("the Service"). By creating an account, clicking "I acknowledge" on a disclosure dialog, or otherwise using the Service, you agree to these Terms.
CareCost Estimate is an informational reference for healthcare providers. The Service provides tools to:
The Service is intended solely to display existing medical information, publicly-reported pricing data, and recommendations that a qualified healthcare professional can independently review before acting. It is not intended to replace clinical or billing judgment.
The Service does not provide medical, reimbursement, coding, billing, or legal advice. All outputs are estimates based on data available at the time of the query, including CMS-published ASP pricing, the CMS NDC-HCPCS crosswalk, openFDA drug listing data, payer-published fee schedules, Medicare Advantage and commercial contract data where made available, and manufacturer- or foundation-published patient assistance program terms.
Estimates are not a guarantee, promise, or statement of:
The Service does not include all possible or required billing and coding options for any drug listed. Actual patient costs and provider reimbursement may differ substantially due to payer-specific contracts, formulary and coverage decisions, claim adjudication variations, coordination of benefits, retroactive benefit changes, patient eligibility changes, and other factors outside of the Service's knowledge.
It is the sole responsibility of the healthcare provider to refer to, verify, and comply with payer-specific policies regarding coding, coverage, prior authorization, and billing before submitting any claim or counseling any patient on expected out-of-pocket cost.
The Service is designed to meet the criteria of a non-device clinical decision support ("CDS") software function under Section 520(o)(1)(E) of the Federal Food, Drug, and Cosmetic Act, as amended by the 21st Century Cures Act. Specifically, the Service:
Our Methodology and Data Sources page describes, in plain language, the inputs, data sources, calculation logic, update cadence, and known limitations of the Service. Users are expected to consult the Methodology page before relying on any output.
Pricing estimates in this Service are derived, in part, from public CMS data including the Medicare Part B Average Sales Price (ASP) Pricing Files and the NDC-HCPCS Crosswalk, updated quarterly. The absence or presence of a HCPCS code, NDC, or payment limit in CMS data does not indicate whether Medicare or any other payer covers a particular product, and products not listed may still be reimbursable under applicable payer policy. CMS disclaims responsibility for any liability attributable to end-user use of this data and is not a party to these Terms.
You agree not to:
The Service's databases — including the payer rate benchmarks derived from insurers' machine-readable files, the coverage-policy rules extracted and structured from payer documents, the assistance-program directory, drug profiles, crosswalks, reference pages and the software that produces them — are original compilations selected, verified, arranged and maintained by CareCost. They are protected as compilations under United States copyright law (17 U.S.C. § 103) and as trade secrets where not publicly displayed, in addition to any protection for the underlying public records, which CareCost does not claim to own. Individual public facts (a CMS payment limit, a published policy) remain free for anyone to use; the selection, verification, structure and arrangement of them here do not.
Except as expressly permitted by these Terms or a separate written data license, you may not copy, cache beyond ordinary browser caching, harvest, crawl, scrape, extract, or otherwise reproduce any substantial part of these compilations, whether by automated means or by hand, and you may not build, train, seed or benchmark a competing product, model or dataset from them. Per-account fingerprints and seeded provenance records may be present in data delivered to your account; they identify the source of any copy.
Accounts, entitlements, per-query gates, rate limits and similar controls are technological measures that control access to these works. Circumventing them — including by automated requests, credential sharing, or session or IP rotation designed to defeat a limit — or providing tools or services to do so, is prohibited by these Terms and by 17 U.S.C. § 1201, independently of any claim in the underlying facts.
Subject to these Terms, CareCost grants the practice named on your account a limited, non-exclusive, non-transferable, revocable license, for as long as the account is in good standing, to access and use the compilations described above (a) through the Service's own interfaces, (b) for the practice's internal operations — estimating, verifying and communicating the cost and coverage of treatments for the patients it treats and the claims it submits — and (c) to produce and keep estimates, summaries and exports for those patients and claims as its own business records.
The license does not permit you to: retain, copy or export any substantial part of a compilation as such (for example, the rates or rules for more drugs, payers or states than the practice has a present clinical or billing need for); load compilation data into any other software, database, model or dataset, or use it to build, train, seed, calibrate or benchmark one; disclose it to anyone other than the patient, payer or referring provider concerned; or share access with anyone outside the practice named on the account. Volume, API, bulk, research and redistribution uses require a separate written data license — contact legal@carecostestimate.com.
When your account ends, this license ends with it. You may keep the estimates, summaries and exports you produced for your own patients and claims. Every other copy of compilation data in your possession — caches, spreadsheets, extracts, database loads — must be deleted within 30 days, and on request you will confirm in writing that this has been done. Sections 7, 11, 12, 13 and 17 survive the end of the account.
Data delivered through the Service carries this license by reference (an X-Data-License header and a _license field in machine-readable responses). Receiving the data without that notice, or from any source other than the Service, does not enlarge the license.
CareCost respects the intellectual property of others. If you believe content on the Service infringes a copyright you own or control, send a notice meeting the requirements of 17 U.S.C. § 512(c)(3) to our designated agent at legal@carecostestimate.com (subject line "DMCA notice"), including the work claimed to be infringed, the URL of the material, your contact details, a statement of good-faith belief, a statement of accuracy under penalty of perjury, and your physical or electronic signature. We may remove or disable access to the material and notify the account that posted it, and we terminate the accounts of repeat infringers. Counter-notices under § 512(g) go to the same address. CareCost likewise enforces its own rights under this section against copies of its compilations hosted elsewhere.
Our handling of your data is governed by our Privacy Policy. Key points:
TO THE MAXIMUM EXTENT PERMITTED BY LAW, THE SERVICE IS PROVIDED "AS IS" AND "AS AVAILABLE," WITH ALL FAULTS AND WITHOUT WARRANTY OF ANY KIND, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHERWISE. CARECOST EXPRESSLY DISCLAIMS ALL WARRANTIES, INCLUDING THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, QUIET ENJOYMENT, ACCURACY, AND NON-INFRINGEMENT.
CARECOST MAKES NO WARRANTY THAT THE SERVICE WILL BE UNINTERRUPTED, ERROR-FREE, COMPLETE, CURRENT, OR FREE OF HARMFUL COMPONENTS, OR THAT ANY OUTPUT OF THE SERVICE WILL BE ACCURATE OR RELIABLE.
TO THE MAXIMUM EXTENT PERMITTED BY LAW, IN NO EVENT SHALL CARECOST, ITS AFFILIATES, OFFICERS, EMPLOYEES, OR LICENSORS BE LIABLE FOR ANY INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, PUNITIVE, OR EXEMPLARY DAMAGES, INCLUDING BUT NOT LIMITED TO DAMAGES FOR LOST PROFITS, LOST REVENUE, LOST REIMBURSEMENT, DENIED CLAIMS, COVERAGE DETERMINATION ERRORS, OR COST-ESTIMATE DISCREPANCIES, WHETHER OR NOT CARECOST HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.
CARECOST'S TOTAL AGGREGATE LIABILITY ARISING OUT OF OR RELATING TO THESE TERMS OR THE SERVICE SHALL NOT EXCEED THE GREATER OF (A) THE AMOUNTS PAID BY YOU TO CARECOST UNDER THESE TERMS IN THE TWELVE (12) MONTHS IMMEDIATELY PRECEDING THE EVENT GIVING RISE TO LIABILITY, OR (B) ONE HUNDRED UNITED STATES DOLLARS (USD $100). [Cap amount pending legal review.]
You agree to defend, indemnify, and hold harmless CareCost, its affiliates, officers, directors, employees, agents, and licensors from and against any and all claims, liabilities, damages, losses, and expenses (including reasonable attorneys' fees) arising out of or in any way connected with: (a) your access to or use of the Service; (b) your submission of any claim, prior authorization, or patient communication based on Service output; (c) your violation of these Terms; (d) your violation of any third-party right, including any payer policy or federal or state law; or (e) any dispute between you and a patient, payer, or other third party.
We aim for high availability but do not guarantee uninterrupted service. Planned maintenance will be communicated in advance where practical. Enterprise customers receive priority support.
We may suspend or terminate your account if you violate these Terms or if required by applicable law. You may cancel your account at any time through Settings or by contacting us. Upon termination, your data will be retained for 30 days and then permanently deleted, except where retention is required by law or for tax, audit, or dispute-resolution purposes. The data license in Section 7 ends with the account, on the terms stated there.
We may update these Terms from time to time. Material changes will be communicated via email and a re-acknowledgement dialog shown on next login. Continued use of the Service after changes take effect constitutes acceptance of the updated Terms.
[This section is pending legal review. Expected content: choice of law, exclusive venue, waiver of jury trial, and binding individual arbitration with class-action waiver, subject to applicable law. Users will be re-prompted to accept updated Terms when this section is finalized.]
These Terms, together with our Privacy Policy, HIPAA Compliance notice, and Methodology, constitute the entire agreement between you and CareCost regarding the Service and supersede all prior agreements. If any provision of these Terms is held unenforceable, the remaining provisions will remain in full force and effect.
[Draft — pending legal review.] This Section 19 applies specifically to CareCost Optimizer, an optional add-on to the Service available to practices with an active CareCost Estimate subscription.
The remaining provisions of these Terms — including Sections 2 (Informational Estimates Only), 9 (Warranty Disclaimer), 10 (Limitation of Liability), and 11 (Indemnification) — apply in full to your use of Optimizer.
For questions about these Terms, contact us at legal@carecostestimate.com.