System and method for selecting healthcare management
The present invention is directed to a system and method which allows a prospective insured to make an informed decision on healthcare insurance or a specific health care management decision by using a current medical profile to assist in their selection. Based on past medical care, as obtained from payor data, a number of different plans, each having different providers, different deductibles, different maximums, different reimbursement policies, etc., a person can make an informed decision. When a family has different payors for different family members, a proper blend of payors can be more easily selected since the payors (or a single payor) has a medical profile of each family member and also has information on providers in the network, prescription policies, deductibles, maximums, etc.
1. An online method for assisting a user in selecting a medical reimbursement plan, said method comprising:
abstracting, by a processor, first medical information included with at least one medical reimbursement claim intended for a first payor from one or more medical providers before the at least one medical reimbursement claim reaches the first payor, said abstracted first medical information pertaining to a particular user, wherein the abstracting includes converting the first medical information by at least one adaptor from one or more formats to one or more second formats, removing first subsets of the converted first medical information pertinent to selection of a medical reimbursement plan and storing the first subsets of converted medical information in a patient profile database;
presenting by the processor an online questionnaire to the user to obtain medical and non-medical information pertinent to the particular user;
receiving, by the processor, second medical information from the particular patient responsive to questions administered to the particular user;
receiving, by the processor, first non-medical information from the particular user responsive to questions administered to the particular user;
abstracting, by the processor, second non-medical information from incoming external information intended for a first payor from one or more external sources before the incoming external information reaches the first payor, said abstracted second non-medical information pertaining to the particular user, wherein the abstracting includes converting the second non-medical information by at least one adaptor from one or more formats to one or more second formats, removing second subsets of the converted non-medical information pertinent to selection of a medical reimbursement plan and storing the second subsets of converted non-medical information in a patient profile database;
retrieving, by the processor from the patient profile database, the first and second subsets of converted medical and converted non-medical information;
obtaining, by the processor, medical reimbursement plan information for multiple individual medical reimbursement plans;
comparing, by the processor, the first and second subsets of converted medical and converted non-medical information, the second medical information, and the first non-medical information, with the medical reimbursement plan information for each individual medical reimbursement plan; and
providing to the particular user by the processor an evaluation of each of the individual medical reimbursement plans based on the comparison to assist the particular user with the selection of at least one of the individual medical reimbursement plans;
wherein the processor evaluates each of the individual medical reimbursement plans for a particular medical procedure identified by the user in the second medical information;
and further wherein providing the evaluation of each of the individual medical reimbursement plans to the particular user includes displaying the comparisons between the individual medical reimbursement plans on a computer screen.
2. The method according to claim 1 , wherein the medical reimbursement plan information for each individual medical reimbursement plan includes medication formularies, benefits, funding mechanisms, limits, deductibles, in-network and out-of-network fees, prescription costs and co-pay charges.
3. The method according to claim 1 , wherein the multiple individual medical reimbursement plans include plans available to the user through a spouse and over-the-counter.
4. The method according to claim 3 , further including:
abstracting, by the processor, additional medical information included with at least one medical reimbursement claim intended for a second payor from one or more medical providers before the at least one medical reimbursement claim reaches the second payor, said abstracted additional medical information pertaining to the spouse of the particular user, wherein the abstracting includes converting the additional medical information by at least one adaptor from one or more formats to one or more second formats, removing third subsets of the converted additional medical information pertinent to selection of a medical reimbursement plan and storing the third subsets of converted additional medical information in a patient profile database;
retrieving, by the processor from the patient profile database, the first, second and third subsets of converted medical, converted non-medical information and converted additional medical information;
comparing, by the processor, the first, second and third subsets of converted medical, converted non-medical information and converted additional medical information, the second medical information, and the first non-medical information, with the medical reimbursement plan information for each individual medical reimbursement plan; and
providing to the particular user by the processor an evaluation of each of the individual medical reimbursement plans based on the comparison to assist the particular user with the selection of at least one of the individual medical reimbursement plans.
5. The method according to claim 4 , wherein the first and second payors are different.
6. The method according to claim 1 , wherein the one or more external sources include a credit card profile system.
7. The method according to claim 1 , wherein the first subset of medical information includes less information than is included in the at least one medical reimbursement claim.
8. The method according to claim 1 , wherein the second subset of non-medical information includes less information than is included in the incoming external information.
9. An online method for assisting a user in selecting a medical reimbursement plan, said method comprising:
abstracting, by a processor, first medical information included with at least one medical reimbursement claim intended for a first payor from one or more medical providers before the at least one medical reimbursement claim reaches the first payor, said abstracted first medical information pertaining to a particular user, wherein the abstracting includes converting the first medical information by at least one adaptor from one or more formats to one or more second formats, removing first subsets of the converted first medical information pertinent to selection of a medical reimbursement plan and storing the first subsets of converted medical information in a patient profile for the particular user;
abstracting, by the processor, first non-medical information from incoming external information intended for a first payor from one or more external sources before the incoming external information reaches the first payor, said abstracted first non-medical information pertaining to the particular user, wherein the abstracting includes converting the first non-medical information by at least one adaptor from one or more formats to one or more second formats, removing second subsets of the converted non-medical information pertinent to selection of a medical reimbursement plan and storing the second subsets of converted non-medical information in a patient profile for the particular user;
presenting by the processor an online questionnaire to the particular user to obtain medical and non-medical information pertinent to the particular user;
receiving, by the processor, second medical information from the particular patient responsive to questions administered to the particular user;
retrieving, by the processor from the patient profile, the first and second subsets of converted medical and converted non-medical information;
obtaining, by the processor, medical reimbursement plan information for multiple individual medical reimbursement plans;
comparing, by the processor, the first and second subsets of converted medical and converted non-medical information with the medical reimbursement plan information for each individual medical reimbursement plan; and
providing to the particular user by the processor an evaluation of each of the individual medical reimbursement plans based on the comparison to assist the particular user with the selection of at least one of the individual medical reimbursement plans;
wherein the processor evaluates each of the individual medical reimbursement plans for a particular medical procedure identified by the user in the second medical information;
and further wherein providing the evaluation of each of the individual medical reimbursement plans to the particular user includes displaying the comparisons between the individual medical reimbursement plans on a computer screen.
10. The method according to claim 9 , wherein the medical reimbursement plan information for each individual medical reimbursement plan includes medication formularies, benefits, funding mechanisms, limits, deductibles, in-network and out-of-network fees, prescription costs and co-pay charges.
11. The method according to claim 9 , wherein the multiple individual medical reimbursement plans include plans available to the user through a spouse and over-the-counter.
12. The method according to claim 11 , further including:
abstracting, by the processor, additional medical information included with at least one medical reimbursement claim intended for a second payor from one or more medical providers before the at least one medical reimbursement claim reaches the second payor, said abstracted additional medical information pertaining to the spouse of the particular user, wherein the abstracting includes converting the additional medical information by at least one adaptor from one or more formats to one or more second formats, removing third subsets of the converted additional medical information pertinent to selection of a medical reimbursement plan and storing the third subsets of converted additional medical information in a patient profile database;
retrieving, by the processor from the patient profile database, the first, second and third subsets of converted medical, converted non-medical information and converted additional medical information;
comparing, by the processor, the first, second and third subsets of converted medical, converted non-medical information and converted additional medical information with the medical reimbursement plan information for each individual medical reimbursement plan; and
providing to the particular user by the processor an evaluation of each of the individual medical reimbursement plans based on the comparison to assist the particular user with the selection of at least one of the individual medical reimbursement plans.
13. The method according to claim 12 , wherein the first and second payors are different.
14. The method according to claim 9 , wherein the one or more external sources include a credit card profile system.
15. The method according to claim 9 , wherein the first subset of converted medical information includes less information than is included in the at least one medical reimbursement claim.
16. The method according to claim 9 , wherein the second subset of converted non-medical information includes less information than is included in the incoming external information.