System and Method for Obtaining, Maintaining and Maximizing Healthcare Benefits

• US 20080033756A1
• Filed: 08/01/2007
• Published: 02/07/2008
• Est. Priority Date: 08/01/2006
• Status: Active Grant

• Current Assignee: My Coverage Plan, Inc.
• Original Assignee: My Coverage Plan, Inc.
• Inventors: Peterson, Robert
• Granted Patent: US 8,126,727 B2
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/00 Administration; Management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 40/67 for remote operation
• CPC Class Codes: G16H 70/00 ICT specially adapted for the handling or processing of medical references

Abstract

A system and method for obtaining, maintaining, and maximizing health care coverage benefits for individuals and families is provided. Patient data is applied to health care coverage program criteria and a patient specific coverage report is generated. Notification alerts are generated and provide a users change event notifications. Proximity alerts are generated and provided within the coverage report, identifying potential loss and gain of coverage benefits and eligibility.

Claims

1. A system for identifying and maintaining patient health care benefits, comprising:

a relational database, the database having access to health care benefits program data, the program data includes criteria for participation in the program;

a memory storage device configured for storage of health care related data; and

a processor for controlling the system, wherein the processor applies the health care criteria to the health care related data and generates eligibility statistics, wherein the processor generates a user notification based upon occurrence of a change event.

2. The system according to claim 1 wherein a change event is selected from the group consisting of a change in date, a change in criteria, a change in program status, a change in patient data, and a change in coverage needs.

3. The system according to claim 1 further comprising an interface having access levels selected from the group consisting of consumer access level, provider access level, and advocate access level.

4. The system according to claim 1 wherein the processor includes a self-screening tool, wherein the tool allows a user to input data through the user interface and manually apply program criteria to the health related data.

5. The system according to claim 1 further comprising a web server, wherein the interface is located remotely with respect to the controller, the controller and interface being connected through a web server.

6. The system according to claim 5 wherein the memory storage device includes audio data files having information selected from the group consisting of benefits eligibility information, benefits coverage strategy information, and user tutorials.

7. The system according to claim 6 wherein the memory storage device includes video data segments having health care coverage data.

8. The system according to claim 1 wherein the memory storage device further includes a reference library, the reference library having data files for user education.

12. The method according to claim 2, further comprising the step of providing updated eligibility status notification for high and medium probability benefits programs.

9. A method for obtaining and maintaining patient benefits comprising the following steps:

receiving a patient transferal;

receiving patient data;

based upon the patient data, applying benefits coverage criteria to the patient data;

identifying benefits programs, wherein the benefits programs provide health care coverage benefits to the patient;

providing a benefits program application for identified benefits programs;

submitting benefits program applications;

receiving benefits program enrollment verification;

obtaining updated patient data;

dynamically providing a benefits program roadmap, the roadmap providing a benefits program timeline and program criteria necessary for maintaining benefits coverage; and

providing a change event status notification, the notification including an actual or potential change event that alters benefits coverage based upon the patient data and program criteria.

10. The method according to claim 9 wherein identifying benefits programs includes identifying high probability programs and medium probability programs.

11. The method according to claim 9 further comprising the following step:

providing a health care coverage plan report, wherein the report provides information to the user including benefit program eligibility and a benefits coverage roadmap.

15. The method according to claim 9 wherein the change of event status notification provides a user with eligibility and benefits maintenance information, wherein the notification reduces the likelihood that the patient will become uninsured.

13. A method for maintaining and maximizing health care coverage comprising the steps of:

entering patient data into a memory storage device;

based upon the patient data, applying benefits coverage criteria to the patient data;

identifying additional benefits programs, wherein the benefits programs provide health care coverage benefits to the patient;

entering updated patient data into a memory storage device, wherein the updated patient data is dynamically applied to the criteria;

dynamically providing a benefits program roadmap, wherein the roadmap prompts the user to fulfill healthcare benefits criteria; and

providing a change event status notification, the notification including potential loss of benefits data and potential new benefits opportunities.

14. The method according to claim 13 further comprising the following steps:

based upon program existence, obtaining new programs and new program criteria, wherein the patient data is applied to the new programs; and

based upon eligibility, generating a new health care coverage report for a patient.

16. The method according to claim 13 further comprising the following step:

based upon patient data, providing a benefits coverage proximity alert, wherein the proximity alert identifies potential benefits coverage programs.

17. The method of claim 13 further comprising the following step:

based upon patient data, providing a benefits coverage proximity alert, wherein the proximity alert identifies potential loss of existing coverage.

18. The method of claim 13 further comprising the following step:

recording interactions between a first advocate and the patient, wherein the interaction recordation enhances advocacy for the patient when interacting with a second advocate.

19. A method for providing a patient-specific benefits coverage report comprising the following steps:

inputting patient-specific data into a memory storage device;

inputting benefits program criteria into a relational database;

applying the user-specific data to the program criteria;

generating a patient-specific benefits coverage report, the report comprising a benefits section, a benefits maintenance roadmap and benefits program proximity alert section, the benefits section providing currently available benefits and the roadmap providing user-specific program requirements, wherein the proximity alert section provides potential benefits program eligibility based upon patient-specific data and key program requirements.

20. A health benefits coverage screening system comprising:

a graphical user interface for accessing a relational database, the database configured to identify health care benefits coverage options for health care consumers; and

a multimedia health care benefits resource library having health care coverage tutorials.

21. The system according to claim 20 wherein the health care coverage options are public and private.