Note: Descriptions are shown in the official language in which they were submitted.
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PET INSURANCE SYSTEM AND METHOD
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
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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:
Figure 1 is a diagram of an implementation of a pet medical insurance system;
Figure 2 illustrates more details of the pet medical insurance system;
Figure 3 illustrates an example of a user interface of the pet medical
insurance system;
Figure 4 illustrates a method of interacting with hospital appointment
information and
providing insurance action options;
Figure 5 illustrates an example of a user interface of appointment data and
insurance
interaction;
Figure 6 illustrates a method for offering insurance, tracking insurance
offers, and
providing insurance coverage and eligibility details;
Figure 7 illustrates an example of a user interface for offering pet insurance
coverage to a
pet owner;
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Figures 8A and 8B illustrate an example of a user interface for tracking
insurance
offers;
Figure 9 illustrates an example of a user interface displaying the status of a
particular
pet's medical insurance coverage and eligibility;
Figure 10 illustrates a method for requesting and receiving medical record
information;
Figures 11A and 11B illustrates an example of a user interface for medical
records
requests;
Figures 12A and 12B illustrates an example of a user interface for completing
medical
records requests;
Figure 13 illustrates a method for submitting and processing a claim in the
pet
insurance system;
Figures 14A and 14B illustrate an example of a user interface for submitting
claims in
the pet insurance system;
Figure 15 illustrates an example of a user interface indicating claims
outcomes; and
Figure 16 illustrates an example of a user interface for claims submission and
payment
tracking.
Detailed Description of One or More Embodiments
Another aspect of the present disclosure relates to a pet medical insurance
system,
comprising: a backend component implemented on a computer, the backend
component
comprising a services component that is configured to be coupled to and
communicate with a
pet insurance component in a veterinary practice over a communication path,
wherein the
services component receives, from the pet insurance component over the
communication
path, one or more pieces of data about the one or more treatments and
procedures for a
particular patient by the veterinarian practice; a data integration system
connected to the pet
insurance component in the veterinary practice and in communication with the
backend
component, wherein the data integration system receives data from the pet
insurance
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component and maps the data according to the services component of the backend
system,
thereby limiting data traffic between the backend component and the pet
insurance
component, the data integration system being integratable with the pet
insurance component
in the veterinary practice via an abstracted engine and being integratable
with additional pet
insurance components in a plug-and-play manner; the backend component further
comprising
an enrollment processing component and claim processing component, the
enrollment
processing component configured to receive a request for insurance coverage
for a particular
patient and issue an insurance offer to an owner of that particular patient;
the claim processing
component configured to process a claim for one or more treatments and
procedures for the
particular patient and pay an amount directly to the veterinary practice; and
wherein the claim
processing component rapidly processes the claim so that the veterinary
practice is informed
of the claim outcome paid quickly.
Another aspect of the present disclosure relates to a method of providing pet
medical
insurance using a backend component implemented on a computer, comprising:
receiving, by
a services component of the backend component, for a veterinary practice, one
of more pieces
of data about one of a treatment and procedure for a particular animal;
receiving, by a data
integration system connected to a pet insurance component in the veterinary
practice and in
communication with the backend component, data from the pet insurance
component, and
mapping the data by the data integration system according to the services
component of the
backend system, thereby limiting data traffic between the backend component
and the pet
insurance component, the data integration system being integratable with the
pet insurance
component in the veterinary practice via an abstracted engine and being
integratable with
additional pet insurance components in a plug-and-play manner; 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 particular animal and issuing an
insurance offer
for the particular animal; and processing, using a claims processing component
of the backend
component, a claim for one of the treatment(s) and the procedure(s) for the
particular animal,
wherein the claim processing component rapidly processes the claim and pays
the veterinary
practice directly, where applicable.
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Another aspect of the present disclosure relates to a pet insurance system,
comprising:
a veterinary practice system having a pet insurance component; a backend
component
implemented on a computer, the backend component comprising a services
component that is
configured to be coupled to and communicate with the pet insurance component
in a veterinary
practice over a communications path, wherein the services component receives,
from the pet
insurance component over the communications path, one or more pieces of data
about one of a
treatment and a procedure for a particular animal by the veterinary practice;
a data integration
system connected to the veterinary practice system and in communication with
the backend
component, wherein the data integration system receives data from the pet
insurance
component and maps the data according to the services component of the backend
system,
thereby limiting data traffic between the backend component and the veterinary
practice
system, the data integration system being integratable with the pet insurance
component in the
veterinary practice via an abstracted engine and being integratable with
additional pet
insurance components in a plug-and-play manner; and the backend component
further
comprising an enrollment processing component and a claim processing
component, the
enrollment processing component configured to receive a request for the
particular animal and
issue an insurance offer to an owner of the particular animal for insurance
for the animal and
the claim processing component configured to process a claim for the
treatment(s) and the
procedure(s) for the particular animal and pay an approved claim amount to the
veterinary
practice; and wherein, the claim processing component rapidly processes the
claim so that the
veterinarian is paid quickly.
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
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disclosure below, a veterinary practice refers to a hospital, clinic or
similar where services are
provided for an animal.
Figure 1 is a diagram of an implementation of pet insurance system (100). The
implementation in Figure 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 i0S,
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 device 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
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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
Figure 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 pct insurance
system, and stores the
information about each pet insurance claim in the system.
Figure 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
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system (300) flows into the data integration agent (200) and the data
integration agent (200)
connects to and communicates with the backend component (106). 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). The client/browser
allows submitting
claims, issuing insurance offers, searching PIMS data for clients,
appointments, mapping clients
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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 Tnipanion 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 Figure 2. Sample data is included in the
below table:
Sample Data Exchanged Enrollment Sample Data Claims Sample Data
Between the Veterinary
Practice & Trupanion
= 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
infonnation 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
Tnipanion'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)
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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.
Figure 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).
Figure 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).
Figure 5 illustrates an example of a user interface displaying the appropriate
insurance based on
the method illustrated in Figure 4.
Figure 6 illustrates a method (700) for obtaining insurance and tracking
insurance offers
.. using the pet insurance system and Figure 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
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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 Figure
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, 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,
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 Figure 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.
Figures 8A and 813 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. Figure 9 illustrates an example of a user interface of a particular
pet's insurance
coverage eligibility once the insurance offer has been activated.
Figure 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 Figure 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. Figures
11A and 11B
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illustrate an example of a user interface for notification of a request for
medical records and
tracking of medical records requests. Figures 12A and 12B illustrate an
example of a user
interface for submitting requested records and completing medical records
requests.
Figures 13 illustrates a method (900) for submitting and processing a claim in
the pct
insurance system. Since the backend component and each computing device in the
veterinary
practice are integrated, as seen in Figure 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 and the veterinary practice submits a
claim (see Figure 14A
for an example) for the treatment using a claim faun (such as shown in Figure
14B) that is
generated by the client/browser (201) in combination with the data integration
agent (200). 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.
Figure 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.
Figure 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.
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