US20200167731A1

US20200167731A1 - Pet insurance system and method

Info

Publication number: US20200167731A1
Application number: US16/779,338
Authority: US
Inventors: Kerri Marshall; Darryl Rawlings; Kathryn Plowman; Christopher Cappelletti
Original assignee: Trupanion Inc
Current assignee: Trupanion Inc
Priority date: 2013-03-15
Filing date: 2020-01-31
Publication date: 2020-05-28
Also published as: US10909501B2; US20180349852A1; US20200364667A1

Abstract

This disclosure relates to a system and method implemented to facilitate real-time medical coverage for veterinary hospitals. More specifically, the disclosure as a pet medical insurance system and method utilizes data available in veterinary hospital practice information systems to facilitate real-time insurance enrollment and claims processing.

Description

PRIORITY CLAIMS/RELATED APPLICATIONS

This application claims priority under 35 U.S.C. § 120 and is a continuation of U.S. patent application Ser. No. 16/023,624, filed on Jun. 29, 2018, and entitled “Pet Insurance System and Method,”, which claims priority under 35 U.S.C. § 120 and is a continuation in part of U.S. patent application Ser. No. 14/924,606, filed on Oct. 27, 2015, now U.S. Pat. No. 10,013,530, and entitled “Pet Insurance System and Method,” which in turn claims priority under 35 U.S.C. § 120 and is a continuation in part of U.S. patent application Ser. No. 14/210,079, filed on Mar. 13, 2014, and entitled “Pet Insurance System and Method,” which in turn claims priority to and the benefit under 35 U.S.C. § 119(e) of U.S. Provisional Patent Application Ser. No. 61/801,404, filed on Mar. 15, 2013, and entitled “Pet Insurance System and Method,” the entirety of each of which is incorporated herein by reference.

BACKGROUND

Veterinary hospitals provide many medical services during the course of caring for a patient. Pet insurance is one of these many services. Often, patients have health problems that require veterinary care above and beyond what a pet owner is prepared to pay out-of-pocket at the time services are provided, even when they have pet insurance coverage. The pet owner files a claim after leaving the veterinary practice and receives notice of coverage, eligibility and payment, if applicable, from the insurance company. These processes and systems are cumbersome and do not allow a pet owner to rapidly obtain or utilize pet medical insurance.
For the veterinary hospital, existing systems do not provide them with real-time, accurate information about the status of a pet's insurance policy, eligibility of coverage, status of a claim, or facilitate the offering of pet insurance coverage. Most systems are not responsive enough to effectively aid a veterinary practice in managing their practice, frustrating the hospital and the pet owner with the delay.
Additionally, due to the delay in claims processing and the need for the pet owner to cover the expense of medical services at time of service and prior to being reimbursed by the insurance company, the hospital must often provide alternate courses of care that are less expensive, more affordable for pet owners. This is counter-intuitive to the purpose of pet medical insurance coverage.
Thus, it is desirable to provide a pet medical insurance system and method to overcome the above limitations and it is to this end that the disclosure is directed. It is also within the scope of the disclosure to facilitate medical coverage and services at veterinary hospitals outside of pet insurance, such as wellness plans, radiology and lab, and similar services provided at veterinary hospitals utilizing the same system and method implementation.

BRIEF DESCRIPTION OF THE DRAWINGS

The disclosure will be better understood if reference is made to the accompanying drawings, in which:

FIG. 1 is a diagram of an implementation of a pet medical insurance system;

FIG. 2 illustrates more details of the pet medical insurance system;

FIG. 3 illustrates an example of a user interface of the pet medical insurance system;

FIG. 4 illustrates a method of interacting with hospital appointment information and providing insurance action options;

FIG. 5 illustrates an example of a user interface of appointment data and insurance interaction;

FIG. 6 illustrates a method for offering insurance, tracking insurance offers, and providing insurance coverage and eligibility details;

FIG. 7 illustrates an example of a user interface for offering pet insurance coverage to a pet owner;

FIGS. 8A and 8B illustrate an example of a user interface for tracking insurance offers;

FIG. 9 illustrates an example of a user interface displaying the status of a particular pet's medical insurance coverage and eligibility;

FIG. 10 illustrates a method for requesting and receiving medical record information;

FIGS. 11A and 11B illustrate an example of a user interface for medical records requests;

FIGS. 12A and 12B illustrate an example of a user interface for completing medical records requests;

FIG. 13 illustrates a method for submitting and processing a claim in the pet insurance system;

FIGS. 14A and 14B illustrate an example of a user interface for submitting claims in the pet insurance system;

FIG. 15 illustrates an example of a user interface indicating claims outcomes; and

FIG. 16 illustrates an example of a user interface for claims submission and payment tracking.

DETAILED DESCRIPTION OF ONE OR MORE EMBODIMENTS

The disclosure is particularly applicable to a cloud computing architecture pet insurance system and it is in this context that the disclosure will be described. It will be appreciated, however, that the system and method has greater utility.
In the disclosure set forth below, a pet owner is a guardian of the pet and could be the pet owner, pet sitter, or similar pet guardian. In the disclosure set forth below, a patient refers to an animal being treated by a veterinary practice. A patient also may be referred to as “pet”. In the disclosure below, a veterinary practice refers to a hospital, clinic or similar where services are provided for an animal.
FIG. 1 is a diagram of an implementation of pet insurance system 100. The implementation in FIG. 1 is cloud computing architecture. However, the system may be implemented in a client/server architecture, a mainframe architecture, a software as a service model and the like, all of which are within the scope of this disclosure. The system may include one or more computing devices 102, and each computing device may be used by a pet owner to connect to and interact with the pet insurance backend component 106 over a communication path 108. The system may also have one or more computing devices 104 such as 104A, . . . , 104N and each computing device may be used by (or integrated into) a veterinary practice and allow the veterinary practice to interact with a pet insurance backend component 106 or the communications path 108. Each computing device 102, 104 may be a processor based device with storage, memory, a display and wireless or wired connectivity circuits that allow the computing device 102, 104 to interact with the backend component 106. For example, each computing device may be a smartphone device, such as a device operating using the iOS, Android or Symbian operating systems, a personal computer, a client/server system, a terminal, a tablet computer, a cellular phone and any other device that would be capable of interacting with the backend component 106. In one implementation, each of the computing device 104 may have a data integration agent 200 and a client 201 that interacts with the backend component 106. In one implementation, the data integration agent 200 and the client 201 may be a plurality of lines of code executed by the processor of the computing device. In one implementation, each of the computing devices 102, 104 may have a browser that interacts with the backend component 106 displays web pages and allows the user to enter information into forms. In one implementation, the browser may be a plurality of lines of computer code executed by the processor of the computing device 102, 104.
The communication path 108 may be a wired or wireless network that may be unsecure or secure and uses typical protocols for the exchange of data between the computing devices 102, 104 and the backend component 106 For example, the communication path 108 may be an Ethernet network, the Internet, a wireless cellular network, a wireless digital data network and the like or any combination thereof and the system is not limited to any particular communication path 108. In the implementation in which the communication path 108 is the Internet, the communication path 108 may use the known HTTP or HTTPS protocol for data communications.
The backend component 106 may be implemented as one or more computing resources or hardware devices. In one implementation, the backend component 106 may be one or more server computers, one or more cloud computing resources and the like and each resource has one or more processors, memory, persistent storage and the like. The backend component 106 may further comprise a web server 106A online services 106B, a pet insurance management component 106C and data storage and processing 106D that are coupled together as shown in FIG. 1. The web server 106A that may be implemented as a hardware web server or a software implemented web server, may generate and exchange web pages with each computing device 102, 104 that is using a browser. The online services—Trupanion Central Services, or TCS—106B, may be implemented as a plurality of lines of computer code and may generate or exchange information with computing devices 102, 104 directly or through communication path 108 utilizing SignalR, ServiceBus, or similar notification services. The pet insurance management component 106B may be implemented as a plurality of lines of computer code that are stored in the computing resources and then executed by the processor(s) of the computing resources to implement the pet insurance management functions that are described below in more detail. The data processing and storage device 106D may be a hardware storage device or a software implemented storage device, such as a database, that stores user and veterinary practice information for the system, stores information about each insurance offer, stores information about each pet that is enrolled in the pet insurance system, and stores the information about each pet insurance claim in the system.
The communications path 108 can enable exchange of data between different programmatic elements running on the computing devices 102, 104 and different programmatic elements running on the backend server. For example, in each veterinary practice, the respective computing device 104A . . . 104N can comprise a respective data integration agent 200 and browser 201, each of which can independently communicate data using the communication path 108. The communication path enables communication with a plurality of programmatic elements in the backend component 106, including a web server 106A and online services 106B. The web server 106A can include a web user interface configured to exchange information between the computing devices 104A . . . 104N of the respective veterinary practices and the backend component 106. Each of the computing devices 104A . . . 104N can receive information from users in a practice information management system 300 and communicate with the respective data integration agent 200 of the computing device. The data integration agent thus provides a connection between the user information provided to the practice information management system 300 and the backend component 106 via the communications path 108.
As the data integration agent 200 receives information from the practice information management system 300, the data integration agent 200 caches relevant data such as appointment information, insurance policy claim information, and required associated meta-data. This cached information can be updated as the underlying data is changed. When the data changes, the data integration agent 200 can transmit information indicating the data change to the backend component 106. The backend component can transmit data change notifications in real time to the respective computing devices 104A . . . 104N, thereby informing the devices of data changes in real time. The data change notifications can be sent to an express browser application operating on the computing devices 104A . . . 104N. The user device 102 of pet owners can also receive real-time notifications via a web browser interface, allowing the user device to receive data updates in real time as the user device communicates with the backend 106 via the communications path 108.
FIG. 2 illustrates more details of the pet insurance system and in particular the components in each veterinary practice computing device 104 and the backend component 106 and the interactions between the two. As shown the veterinary practice may have one or more browsers/clients 201, a hospital practice information management system 300, and a data integration agent 200. As shown, data from the hospital practice information management system 300 flows into the data integration agent 200 and the data integration agent 200 connects to and communicates with the backend component 106. Online services 106B of the backend component 106 receives the communications from the data integration agent 200, and communicates with the data integration agent 200 as well as the web user interface 106A and a database 106D for data storage and processing. The database 106D is managed using a database system that allows for interactions with a pet insurance system 106C to handle features such as insurance offers, enrollments, and claims. The data integration agent 200 also connects to and communicates with one or more client/browsers 201 in the computing devices 104. In one implementation, each of the components of the veterinary practice computing device 104 may be a plurality of lines of computer code that are executed by a processor of the computing device 104. The Hospital Practice Information Management System (PIMS) is an existing system used by a veterinary practice that use database and visualization technologies (user interface) with the aim to support various hospital/patient management and administration tasks. Different PIMS manufacturers include different modules that allow for many common hospital technology requirements that may include inventory tracking, procedure codes, connection to diagnostic equipment and service providers, connection to a variety of radiology modalities and services, and invoice generation.
The data integration agent 200 may be provided by the pet insurance backend system 106 and may be installed in the computing device 104 of the veterinary practice. The data integration agent 200 is a system which integrates with these varied systems to provide added value and operational simplicity for employees of the veterinary practice and pet owners. The data integration agent is responsible for retrieving and mapping data from the PIMS 300, sending communications to and receiving information from Trupanion Central Services 106B about claim, insurance offers, and enrollments, and communication with the Trupanion Express clients/browsers 201. The data integration agent 200 employs various technological mechanisms to limit traffic between Trupanion Central Services 106B and Trupanion Express clients/browsers 201, as well as the PIMS 300, creating efficient correspondence between all systems. The data integration agent 200 may include an abstracted engine that allows communication with various PIMS systems on the market today, as well as the ability to integrate with additional in the future in a plug-and-play fashion.
The client/browser 200, is the user interface for Trupanion Express. It communicates with the data integration agent 200 and the web UI 106A with the aim to exchange information between the hospital and the backend component 106. Integrating services provided by the backend system 106 via the web user interface 106A allows the system to provide veterinary practices with current, real-time access to information stored in the backend system 106. The client/browser allows submitting claims, issuing insurance offers, searching PIMS data for clients, appointments, mapping clients between systems, and displaying all of the information for these activities in a digestible way for veterinary practice employees—resulting in improved patient care.
The backend component 106 may further comprise a services component 106B, that may be known as Trupanion Central Services, a data storage and processing component 106D, and a pet insurance system(s) 106C, that may be comprised of enrollment and claims systems that are coupled together as shown in FIG. 2. Sample data is included in the below table:


Sample Data Exchanged
Between the Veterinary
Practice & Trupanion	Enrollment Sample Data	Claims Sample Data

Patient demographics	Policy ID & type	Claims basics
Client demographics	Policy status	Claiming veterinary
Claim form information	Enrollment veterinary	practice information
Invoices/estimates	practice information	Claim outcomes &
Medical record	Policy coverage	amount covered
information	details	Claims payments
Insurance offer
information

In one implementation, each of the components of the backend 106 may be a plurality of lines of computer code that are executed by a processor of the computing device 106. The services component 106B integrates with data storage and processing 106D. The enrollment processing system and claims processing system—pet insurance systems 106C—may interact with the data storage and processing systems 106D allowing insurance offers to be issued and activated and claims to be processed. The services component 106B is a service inside Trupanion's network and processes requests from and sends information to the data integration agent 200 and passes appropriately formed requests to the data storage & processing systems 106D. The data storage and processing system 106D is any location where transactional data for Trupanion's various IT systems is processed and/or stored. The pet insurance system 106C is comprised of the enrollment processing system, the system that issues insurance offers to pet owners, and the claims processing system, the system that catalogs the collection of medical records that enables claims adjudicators to manage and process pet owner claims. The pet insurance system 100 is revolutionary in that it enables claims to be adjudicated very quickly—allowing the pet owner to not pay out-of-pocket expenses at the veterinary practice. Said another way, the pet insurance system 100 allows Trupanion to pay the veterinary hospital directly with the invoice while the customer is waiting to checkout, similar to the concept of “co-pay” in human health care. The pet insurance system 100 allows for near real-time claims submission and claims processing, enabling claim adjudication at point-of-sale at the veterinary practice. A typical system uses typical channels such as fax or mail that support a delayed reimbursement model for veterinary practices and/or pet owners.

FIG. 3 illustrates an example of a user interface 500 of the pet insurance system. The user interface may include a navigation portion 501 that allows the user to navigate around to various parts of the pet insurance system user interface. The user interface may include a status 502 for each pet to indicate the current coverage of that pet. The user interface may further include an action button 503 allowing the user to submit claims or issue an insurance offer to a selected pet. The user interface may have status indicators for current claims transactions 504. The user interface may also have status indicators for current offers of insurance 505.
FIG. 4 illustrates a method 600 for determining the current pet insurance coverage for patient with scheduled appointments in the hospital practice information management system 300 and displaying the appropriate action in the pet insurance system user interface 500. FIG. 5 illustrates an example of a user interface displaying the appropriate insurance based on the method illustrated in FIG. 4.
FIG. 6 illustrates a method 700 for obtaining insurance and tracking insurance offers using the pet insurance system and FIG. 7 illustrates an example of a user interface for offering pet insurance to a pet owner. The pet insurance system makes it easier for a pet owner to get pet insurance and then quickly be able to have proof of the pet insurance in the form of an insurance offer that can be presented to the veterinary practice to establish the insurance of the pet. In the method 700, a veterinary practice may provide a pet owner an insurance offer 701 which is recorded in Trupanion systems 702 through the data integration agent 200. When the veterinary practice offers the insurance to the pet owner, an employee of the veterinary practice may enter the insurance offer into the client 201, such as shown in FIG. 7, and the information about the insurance offer is passed onto the backend component 106 through the data integration agent 200. The pet owner, using a computing device 102, can receive the insurance offer and may then activate the insurance offer, and obtain pet insurance, using an email link or by phone which is sent to the backend component 106. Once the pet owner activates the insurance coverage, policy and eligibility details are created and stored in the system, and the pet owner receives proof of insurance which is also passed back to the veterinary practice through the data integration component 200 so that the veterinary practice receives quick notice of the insurance for the pet. In addition, since the computing device 104 and the backend component 106 are integrated as shown in FIG. 2, all parties involved are rapidly notified of changes to the pet's insurance coverage. For example, this means the veterinary practice can be comfortable that the pet has insurance for the procedure that is about to be performed. The system may also display the treatment or procedure that is, has been or will be performed on a particular patient or by a particular employee at the veterinary practice.
FIGS. 8A and 8B illustrate examples of a user interface for tracking pet insurance offers through the pet insurance system user interface in the client/browser 201 in the veterinary practice. FIG. 9 illustrates an example of a user interface of a particular pet's insurance coverage eligibility once the insurance offer has been activated.
FIG. 10 illustrates a method 800 for requesting and receiving medical record information used to determine a pet's eligibility for insurance coverage. When the pet insurance system is generating the eligibility the computing device 200 and the pet insurance systems 106C may obtain a history of a pet from any veterinary practice that has seen the pet in the past through the data integration component 200. The pet insurance components 106C may then structure that data and generate an eligibility of coverage. The system may then display that eligibility of coverage to the users of the system which allows all of the users to rapidly see the coverage status for a pet in a user interface (refer to FIG. 9). During the course of collecting medical record information for a pet, it may be required for a hospital to respond directly to requests for information utilizing the user interface of the pet insurance system. FIGS. 11A and 11B illustrate an example of a user interface for notification of a request for medical records and tracking of medical records requests. FIGS. 12A and 12B illustrate an example of a user interface for submitting requested records and completing medical records requests.
FIG. 13 illustrates a method 900 for submitting and processing a claim in the pet insurance system. Since the backend component and each computing device in the veterinary practice are integrated, as seen in FIG. 2, and the system has determined a patient's eligible coverage, an insurance claim may be quickly processed by the claims processing component of the pet insurance component 106C. A claim starts when an employee or doctor of a veterinary hospital completes services for a pet. The policy coverage can be verified by the data integration agent 200, which can indicate the verification to the veterinary practice. The system can obtain invoice information from the veterinary practice, which may be sent to the data integration agent 200. The veterinary practice submits a claim (see FIG. 14A for an example) for the treatment using a claim form (such as shown in FIG. 14B) that is generated by the client/browser 201 in combination with the data integration agent 200. The receipt of the claim by the data integration agent 200 can be acknowledged to the veterinary practice. The pet insurance company, through the pet insurance systems 106C, may then process the claim. The pet insurance company has the status of the pet's eligibility for coverage and this is able to quickly approve or deny the insurance claim for the pet. If the claim is approved, the claim may be paid directly to the veterinary practice (in one implementation, electronically via ACH) and then the pet owner pays their portion to the veterinary practice. In this manner the system allows a claim to be quickly processed and then paid if the insurance claim is approved.
FIG. 15 is an example of a user interface of pet insurance system 100 highlighting display of communication from Trupanion to the veterinary practice claim outcome information.
FIG. 16 is an example of a user interface for pet insurance system 100 for tracking of the status of claims submitted and the outcomes and payments for those claims.
While the foregoing has been with reference to a particular embodiment of the invention, it will be appreciated by those skilled in the art that changes in this embodiment may be made without departing from the principles and spirit of the disclosure, the scope of which is defined by the appended claims.

Claims

1. A pet medical insurance claims system, comprising:

a backend component implemented on a computer, the backend component comprising a services component;

a plug-and-play data integration system connected to a practice management system in a veterinary practice and the backend component, wherein the plug-and-play data integration system receives data from the practice management system and maps the data according to the backend system, thereby limiting the data traffic between the backend component and the practice management system, the plug-and-play data integration system being integratable with a second or more different practice management systems for connection thereto;

wherein the data comprises, one or more pieces of information about one or more treatments and procedures for a patient by the veterinarian practice, and wherein, subsequent to an issuance of an insurance offer to an owner of the patient, the backend component is configured to send the data to a claim processing component for processing.

2. The system of claim 1, wherein the backend component comprises the claim processing component and the claim processing component is configured to process a claim for one or more treatments and procedures for the patient.

3. The system of claim 2, wherein the claim processing component is further configured to pay an amount to the veterinary practice after processing a claim.

4. The system of claim 2, wherein the claim processing component is configured to process the claim for one or more treatments and procedures for the patient at the time of completion of the one or more treatments and procedures for the patient.

5. The system of claim 1, wherein the claim processing component is remote from the backend component.

6. The system of claim 1, wherein the backend component further comprises an enrollment processing component configured to receive a request for insurance coverage for a patient and issue the insurance offer to an owner of the patient.

7. The system of claim 1, wherein the claim processing component is configured inform the veterinary practice of the amount paid based on the processing of the claim.

8. The system of claim 1, wherein the backend component further comprises a user interface component that is configured to generate a user interface containing information about the animal for the veterinary practice.

9. The system of claim 1, wherein the backend component further comprises one or more databases that store one or more pieces of the information about one or more of treatments and procedures for the animal by the veterinarian or an employee of the veterinary practice.

10. The system of claim 1, wherein the backend component is configured to generate an insurance claim form.

11. A method of processing pet medical insurance claims using a backend component implemented on a computer, comprising:

receiving, by a services component of the backend component from a first veterinary practice system that is remote from the backend component, one of more pieces of data about one or more treatments and procedures for an animal;

mapping the data from the first veterinary practice system to the first services component, by a plug-and-play data integration system connected to the first veterinary practice system thereby limiting the data traffic between the services component and the first veterinary practice system, the plug-and-play data integration system being integratable with a second or more veterinary practice systems for connection thereto; and

sending claim data based on the mapped data to a claims processing component for processing a pet insurance claim.

12. The method of claim 11 further comprising processing, using a claims processing component of the backend component, a claim for one of the treatment and the procedure for the animal, wherein the claims processing component processes the claim to determine whether a claim is covered by a pet insurance policy.

13. The method of claim 12 further comprising paying a veterinary hospital based determining whether a claim is covered by a pet insurance policy.

14. The method of claim 12, wherein the processing of the claim occurs as at the time of completion of the one or more treatments and procedures for the patient.

15. The method of claim 11 further comprising processing, using a claims processing component remote from the backend component, a claim for the one or more treatments and procedures for the animal.

16. The method of claim 11, further comprising enrolling, by an enrollment processing component, an owner of the animal for pet medical insurance for the animal upon receipt of a request for the insurance of the animal and issuing an insurance offer for the animal.

17. The method of claim 11, further comprising informing, by the claim processing component, the veterinary practice of the amount paid based on the processing of the claim.

18. The method of claim 11 further comprising generating a user interface containing information about the animal.

19. The method of claim 11 further comprising storing the one or more pieces of data about the one or more treatments and procedures for the animal.

20. The method of claim 11 further comprising generating an insurance claim form from the claim data.