Patent Issued for Systems and methods for a health care e-commerce marketplace (USPTO 11763277): Cambia Health Solutions Inc.

2023 OCT 11 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Cambia Health Solutions Inc. (Portland, Oregon, United States) has been issued patent number 11763277, according to news reporting originating out of Alexandria, Virginia, by NewsRx editors.

The patent’s inventors are Berselli, Elizabeth Anne (Portland, OR, US), Chmait, Marcee (North Hills, CA, US), Coogan, Christopher (Portland, OR, US), Cooper, Will (Berkeley, CA, US).

This patent was filed on June 2, 2020 and was published online on September 19, 2023.

From the background information supplied by the inventors, news correspondents obtained the following quote: “BACKGROUND/SUMMARY

“In the modern world, consumers are accustomed to a wide array of options when shopping for goods and services. Furthermore, online shopping enables consumers to make an informed purchasing decision by comparing products by price and quality, for example. However, in today’s health care marketplace, consumers are unable to shop for health care services, which may include medical treatments, dental services, mental health services, prescriptions, alternative health services, and any other medical services or goods, the way they shop for virtually every other good and service.

“Indeed, health care consumers are often uninformed regarding the expenses they are incurring when purchasing health care services. For example, health care consumers are currently limited to visiting a health care provider in order to receive health care services without knowing how much the services will cost until the health care consumer receives an Explanation of Benefits (EOB) statement from his or her health insurance company and a bill from the health care provider. Such EOB statements typically outline the services rendered by using cryptic common procedure terminology (CPT) codes.

“The price of health care services is further obscured by the variability of health care plan benefits. For health care consumers, identifying what health care services may be covered by a health care plan is exceedingly difficult, let alone understanding the extent of coverage. Even when a health care consumer eventually receives an EOB statement, he or she may be surprised to find that his or her health insurance does not cover a health care service that the health care consumer already received and expected to be covered.

“Aside from the obfuscation of health care insurance benefits, health care services and associated prices are highly variable from provider to provider. Such variability results from complex contractual agreements between providers and insurance companies. As a result, health care consumers may expect to pay a particular price for a health care service based on previous experience, only to discover that a different provider charges a different price for the same health care service. Given the closed nature of the current health care marketplace, even health care providers themselves may not be aware of how much they differ cost-wise from other providers.

“The deficiencies of the health care marketplace not only negatively affects health care consumers, but health care providers as well. For example, health care providers provide health care services prior to receiving payment. Furthermore, health care providers may be delayed in receiving payment for their services from a health care consumer for an indeterminate amount of time, possibly resulting in a prolonged debt collection situation that everyone involved would prefer to avoid.

“Thus, health care consumers need a standardized way to shop for and compare health care services. The inventors have recognized the above issues and have devised several approaches to address them. In particular, systems and methods for a health care e-commerce marketplace are provided. In one embodiment, a method comprises, responsive to a query from a user, retrieving from a database a list of responses comprising one or more health care providers offering one or more health care services at a provider-supplied price; filtering the list of responses based on a geographic location included in the query; providing, for display, the filtered list of responses; receiving a payment from the user for a response selected from the filtered list of responses; automatically sending a notification of the payment to a provider associated with the selected response; and responsive to receiving an order fulfillment notification from the provider, automatically providing the payment to the provider. In this way, health care consumers may make informed purchasing decisions when shopping for health care services and health care providers may receive prompt payment for services delivered.

“In another embodiment, a computer-readable storage medium includes an executable program stored thereon, the program configured to cause a computer processor to: retrieve health care claims data from one or more databases; process the health care claims data to identify a combination of current procedural terminology (CPT) codes provided to a plurality of patients in a single health care interaction; assemble the combination of CPT codes into a bundle of health care services; generate a product code for a bundle of health care services; receive a price for the product code from a health care provider; generate a health care service bundle indicator for the health care provider based on the product code; and assign the price to the health care service bundle indicator. In this way, health care services offered by health care providers may be normalized and health care consumers may shop for and purchase health care service bundle indicators in a health care e-commerce marketplace.

“In another embodiment, an apparatus facilitating a health care marketplace comprises a processor and memory storing processor-executable instructions that cause the processor to: receive, from a user, a payment for a bundle of health care services provided by a health care provider prior to the user visiting the health care provider; automatically generate receipt documentation responsive to receiving an order fulfillment notification from a health care provider indicating that the user received the bundle of health care services from the health care provider, wherein the receipt documentation includes one or more current procedural terminology (CPT) codes associated with the bundle of health care services; send, to the user, the receipt documentation formatted for display to the user and including a non-technical description of the one or more CPT codes; and send, to an insurance administrator for a health insurance plan of the user, the receipt documentation formatted as a health care claim. In this way, health care consumers can easily track their health care spending and health care providers no longer need to deal with writing and submitting health care claims to insurance administrators.

“The above summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description. This summary is not intended to identify key features or essential features of the subject matter, nor is it intended to be used to limit the scope of the subject matter. Furthermore, the subject matter is not limited to implementations that solve any or all of the disadvantages noted above or in any part of this disclosure.”

Supplementing the background information on this patent, NewsRx reporters also obtained the inventors’ summary information for this patent: “BACKGROUND/SUMMARY

“In the modern world, consumers are accustomed to a wide array of options when shopping for goods and services. Furthermore, online shopping enables consumers to make an informed purchasing decision by comparing products by price and quality, for example. However, in today’s health care marketplace, consumers are unable to shop for health care services, which may include medical treatments, dental services, mental health services, prescriptions, alternative health services, and any other medical services or goods, the way they shop for virtually every other good and service.

“Indeed, health care consumers are often uninformed regarding the expenses they are incurring when purchasing health care services. For example, health care consumers are currently limited to visiting a health care provider in order to receive health care services without knowing how much the services will cost until the health care consumer receives an Explanation of Benefits (EOB) statement from his or her health insurance company and a bill from the health care provider. Such EOB statements typically outline the services rendered by using cryptic common procedure terminology (CPT) codes.

“The price of health care services is further obscured by the variability of health care plan benefits. For health care consumers, identifying what health care services may be covered by a health care plan is exceedingly difficult, let alone understanding the extent of coverage. Even when a health care consumer eventually receives an EOB statement, he or she may be surprised to find that his or her health insurance does not cover a health care service that the health care consumer already received and expected to be covered.

“Aside from the obfuscation of health care insurance benefits, health care services and associated prices are highly variable from provider to provider. Such variability results from complex contractual agreements between providers and insurance companies. As a result, health care consumers may expect to pay a particular price for a health care service based on previous experience, only to discover that a different provider charges a different price for the same health care service. Given the closed nature of the current health care marketplace, even health care providers themselves may not be aware of how much they differ cost-wise from other providers.”

The claims supplied by the inventors are:

“1. A method for a computing system, comprising: providing, for a consumer, remote access to the computing system over a network via a consumer computing device communicably coupled to the network, wherein the computing system comprises a data-holding subsystem and a logic subsystem, the data-holding subsystem storing machine readable instructions executable by the logic subsystem; providing, for a provider, remote access to the computing system over the network via a provider computing device communicably coupled to the network; and executing the machine readable instructions at the logic subsystem to: receive national claims information from a first non-transitory storage device included in the data-holding subsystem; receive metadata comprising order information, provider listings, order fulfillment data, and medical classification data from a second non-transitory storage device included in the data-holding subsystem; identify one or more current procedural terminology (CPT) codes commonly added to health care services together based on the national claims information and the metadata; generate a standardized health care service bundle identifier based on the one or more identified CPT codes and an identifier taxonomy; display, at the consumer computing device, each of the standardized health care service bundle identifier and a price for the standardized health care service bundle identifier; receive, from the consumer computing device, a prepayment for the standardized health care service bundle identifier, wherein the prepayment is received prior to a particular health care service being provided; place the prepayment into escrow; and responsive to receiving an order fulfillment notification from the provider computing device, wherein the order fulfillment notification indicates that the particular health care service has been provided, automatically transfer the prepayment from escrow to the provider computing device, automatically generate a health care claim in a first format based on the particular health care service, consumer information from the consumer computing device, and provider information from the provider computing device; automatically send the health care claim in the first format to the consumer computing device; automatically generate the health care claim in a second format, the second format different from the first format, based on the particular health care service, the consumer information from the consumer computing device, and the provider information from the provider computing device; and automatically send the health care claim in the second format to a health insurance administrator computing device.

“2. The method of claim 1, wherein the health insurance administrator computing device is communicably coupled to the network and provides remote access for a health insurance administrator to the computing system over the network.

“3. The method of claim 1, wherein the machine readable instructions are further executed at the logic subsystem to: display, at the provider computing device, the standardized health care service bundle identifier; and receive, from the provider computing device, the price for the standardized health care service bundle identifier.

“4. The method of claim 1, wherein the identifier taxonomy comprises a health care service category, a health care service group, a health care service type, a location, and a single unit code, the health care service group corresponding to a first subset of health care services within the health care service category and the health care service type corresponding to a second subset of health care services within the health care service group.

“5. The method of claim 4, wherein the location corresponds to a geographical region, or wherein the location corresponds to a specific health care practice and the single unit code corresponds to a specific provider at the specific health care practice.

“6. The method of claim 1, wherein the machine readable instructions are further executed at the logic subsystem to assemble the one or more identified CPT codes into a bundle of health care services, the standardized health care service bundle identifier representing the bundle of health care services.

“7. The method of claim 6, wherein the bundle of health care services comprises one or more first CPT codes corresponding to a standard service and one or more second CPT codes corresponding to one or more additional services selected by the provider via the provider computing device and/or the consumer via the consumer computing device, or selected based on the identifier taxonomy.

“8. A method for a computing system, comprising: providing, for a consumer, remote access to the computing system over a network via a consumer computing device communicably coupled to the network, wherein the computing system comprises a data-holding subsystem and a logic subsystem, the data-holding subsystem storing machine readable instructions executable by the logic subsystem; providing, for a provider, remote access to the computing system over the network via a provider computing device communicably coupled to the network; and executing the machine readable instructions at the logic subsystem to: receive a prepayment for a standardized health care service bundle identifier from the consumer computing device before a particular health care service is provided, the standardized health care service bundle identifier generated based on one or more current procedural terminology (CPT) codes and displayed at the consumer computing device; place the prepayment into escrow; automatically transfer the prepayment from escrow to the provider computing device upon receiving an order fulfillment notification from the provider computing device; automatically generate a health care claim in a first format based on the particular health care service, consumer information from the consumer computing device, and provider information from the provider computing device, and send the health care claim in the first format to the consumer computing device; and automatically generate the health care claim in a second format based on the particular health care service, the consumer information from the consumer computing device, and the provider information from the provider computing device, and send the health care claim in the second format to a health insurance administrator computing device communicably coupled to the network.

“9. The method of claim 8, wherein the standardized health care service bundle identifier is further generated based on an identifier taxonomy, and wherein the one or more CPT codes are identified based on national claims information received from a first non-transitory device included in the data-holding subsystem and metadata comprising order information, provider listings, order fulfillment data, and medical classification data received from a second non-transitory storage device included in the data-holding subsystem.

“10. The method of claim 8, wherein a price for the standardized health care service bundle identifier is displayed at the consumer computing device with the standardized health care service bundle identifier.

“11. The method of claim 8, wherein the health care claim in the first format is receipt documentation formatted for display to the consumer.

“12. The method of claim 8, wherein the health care claim in the first format includes a non-technical description of the one or more CPT codes.

“13. The method of claim 8, wherein the health care claim in the second format includes a technical description of provided services in a standardized format.

“14. The method of claim 8, wherein the health care claim in the second format includes the one or more CPT codes, medical classifications, insurance information of the consumer, and the provider information.”

For the URL and additional information on this patent, see: Berselli, Elizabeth Anne. Systems and methods for a health care e-commerce marketplace. U.S. Patent Number 11763277, filed June 2, 2020, and published online on September 19, 2023. Patent URL (for desktop use only): https://ppubs.uspto.gov/pubwebapp/external.html?q=(11763277)&db=USPAT&type=ids

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