SYSTEM AND METHOD FOR PROVIDING PRICE ESTIMATES FOR MEDICAL PROCEDURES

• US 20090094055A1
• Filed: 04/02/2008
• Published: 04/09/2009
• Est. Priority Date: 04/02/2007
• Status: Abandoned Application

• Current Assignee: Empowered Benefits LLC (Aflac Incorporated)
• Original Assignee: Empowered Benefits LLC (Aflac Incorporated)
• Inventors: Gage, Stephen M., GAGE, Gaston H. JR.
• Application Number:
  US12/061,629
• Publication Number:
  US 20090094055A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/02 Marketing; Price estimation or determination; Fundraising
• CPC Class Codes: G06Q 30/0283 Price estimation or determination
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records

Abstract

A system for providing price information for medical procedures. The system includes a user interface configured to receive patient information corresponding to a patient, an eligibility engine configured to send a health care benefit inquiry and receive a health care benefit response from an insurer or a clearinghouse for a plurality of insurers based on received patient information, and a pricing engine configured to request and receive price data for a particular medical procedure based on the received patient information. The user interface is further configured to present pricing information to a user based on the received health care benefit response and the received price data.

Claims

1. A system for providing price information for medical procedures, comprising:

(a) a user interface configured to receive patient information corresponding to a patient;

(b) an eligibility engine configured to send a health care benefit inquiry and receive a health care benefit response from an insurer or a clearinghouse for a plurality of insurers based on received patient information; and

(c) a pricing engine configured to request and receive price data for a particular medical procedure based on the received patient information;

(d) wherein the user interface is further configured to present pricing information to a user based on the received health care benefit response and the received price data.

2. The system of claim 1, wherein:

(a) the eligibility engine, by sending the health care benefit inquiry and receiving the health care benefit response, determines whether and to what extent the patient is eligible for insurance benefits; and

(b) the pricing engine communicates with an historical pricing database to receive the price data for the particular medical procedure.

3. The system of claim 2, wherein the patient information comprises information pertaining to the particular medical procedure.

4. The system of claim 2, wherein the patient information comprises insurance information for the patient.

5. The system of claim 2, wherein the user interface comprises an authorization module configured to determine security clearance of a user thereof.

6. The system of claim 2, wherein the user interface is accessible by the user via a network.

7. The system of claim 2, wherein the eligibility engine sends health care benefit inquiries using an ANSI X12N 270 electronic format.

8. The system of claim 2, wherein the eligibility engine receives health care benefit responses using an ANSI X12N 271 electronic format.

9. The system of claim 2, wherein the health care benefit response comprises coverage amounts for which the patient is eligible.

10. The system of claim 9, wherein the health care benefit response further comprises a deductible amount for the patient.

11. The system of claim 9, wherein the health care benefit response further comprises a copayment amount for the patient.

12. The system of claim 2, wherein the user interface is further configured to receive information pertaining to a particular hospital or medical facility.

13. The system of claim 2, wherein the pricing information comprises an estimate of a total cost of the particular medical procedure.

14. The system of claim 2, wherein the pricing information comprises an estimate of an amount that the patient is required to pay in connection with the particular medical procedure.

15. A system for providing price information for medical procedures, comprising:

(a) a user interface accessible to a user via a network and configured to receive patient information corresponding to a patient;

(b) an eligibility engine configured to send a health care benefit inquiry and receive a health care benefit response from an insurer or a clearinghouse for a plurality of insurers based on received patient information to determine whether and to what extent the patient is eligible for insurance benefits; and

(c) a pricing engine configured to communicate with an historical pricing database to request and receive price data for a particular medical procedure based on the received patient information;

(d) wherein the user interface is further configured to present pricing information to the user based on the received health care benefit response and the received price data; and

(e) wherein the pricing information comprises an estimate of an amount that the patient is required to pay in connection with the particular medical procedure.

16. The system of claim 15, wherein the eligibility engine sends health care benefit inquiries using an ANSI X12N 270 electronic format.

17. The system of claim 15, wherein the eligibility engine receives health care benefit responses using an ANSI X12N 271 electronic format.

18. The system of claim 15, wherein the user interface is configured to receive information pertaining to a particular hospital or medical facility.

19. A method of providing price information for medical procedures, comprising:

(a) selecting a medical procedure whose price is to be estimated;

(b) sending a health care benefit inquiry via a first interface;

(c) receiving a health care benefit response via the first interface;

(d) requesting price data, from a database, for the selected medical procedure via a second interface; and

(e) receiving price data, from the database, for the requested medical procedure via the second interface.

20. The method of claim 19, further comprising calculating an estimated price for the medical procedure based on the received health care benefit response and the received price data.