Insurance Plan Rating and Ranking System

• US 20200134691A1
• Filed: 10/31/2018
• Published: 04/30/2020
• Est. Priority Date: 10/31/2018
• Status: Abandoned Application

• Current Assignee: Michael Wiseman Sr
• Original Assignee: Michael Wiseman Sr
• Inventors: Wiseman, SR., Michael
• Application Number:
  US16/176,182
• Publication Number:
  US 20200134691A1
• Time in Patent Office: Days
• CPC Class Codes: G06Q 30/0627 using item specifications
• CPC Class Codes: G06Q 30/0629 for generating comparisons
• CPC Class Codes: G06Q 30/0633 Lists, e.g. purchase orders, compilation or processing
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

The present development is a system for ranking and rating competing healthcare insurance options available in a marketplace based on metrics relevant to an enrollee or patient.

Claims

1. An interactive computer system for building a simultaneous display of two or more health insurance plans that reflect the character of an enrollee comprising providing a computer system which performs the steps of;

a. receiving from a user qualitative inputs regarding an enrollee'"'"'s healthcare preferences;

b. receiving from a user qualitative inputs regarding the ranked relative importance of the elements from (a) for the enrollee;

c. receiving from an automated system quantitative inputs related to the user'"'"'s prior or current behavior as it pertains to insurance usage;

d. receiving from an automated system quantitative inputs regarding regionally available healthcare plans;

e. receiving from an automated system healthcare plan documents for at least 2 preceding years for the plans listed in d;

f evaluating the documents from (e) for changes in at least two of previous years to at least two of cost share, provider network drug formulary, utilization management criteria, government ratings including star ratings, recent network changes;

g. generating, based on (f), relative stability scores for each plan;

h. generating, based on (a), (b), and (c) a set of criteria affecting the suitability of plans for a user;

i. generating a list based on the outputs of the (g) and (h), a list of plans suitable for a user as well as their respective stability scores.

2. The system of claim 1, wherein the user preferences from step (a) include at least two of, the medical providers used by an enrollee, requirements regarding utilitization management including at least one of prior authorization, quantity limits, step rules, and therapy requirements, pre and post treatment procedure guidelines, relationship of plan costs to deductibles, presence of pharmaceuticals or devices on an insurance formulary, plan treatment of predictable and unpredictable costs, level of engagement required by the enrollee for participation in plan features, and additional plan benefits.

3. The system of claim 1, wherein the quantitative inputs from step (c) include at least one of past claim or event data, healthcare providers utilized by the enrollee, healthcare services utilized by the enrollee, healthcare facilities utilized by the enrollee, and enrollee'"'"'s financial information.

4. The system of claim 1, wherein the quantitative inputs regarding appropriate healthcare plans from step (d) include at least one of, participating provider data, plan costs, plan benefits.

5. The system of claim 1, further comprising dynamically generating descriptive language for each plan within the list in step (g), wherein the features of each plan are described to a user in terms responsive to at least one of, the user'"'"'s stated preferences, impact that plan choice would have had on specific past events, and plan stability.

6. An interactive computer system for assisting a user to build a simultaneous display of two or more health insurance plans that reflects the character of an enrollee comprising providing a computer interface which performs the steps of;

a. receiving from a user qualitative inputs regarding the enrollee'"'"'s healthcare preferences;

b. receiving from a user qualitative inputs regarding the ranked relative importance of the elements from (a);

c. receiving from an automated system quantitative inputs related to the enrollee'"'"'s prior or current behavior as it pertains to insurance usage;

d. receiving from an automated system quantitative inputs regarding regionally available healthcare plans;

h. generating, based on (a), (b), and (c) a set of criteria affecting the suitability of plans for an enrollee;

i. generating a list based on the outputs of the (d), a list of plans suitable for a user as well as their respective stability scores;

j. generating based on (a), (c), and (i) natural language “

positioning statements”

that link plan features and benefits in terms of the enrollee and patient'"'"'s actual usage and stated priorities.