Patent Issued for Use determination risk coverage datastructure for on-demand and increased efficiency coverage detection and rebalancing apparatuses, methods and systems (USPTO 11663670): Bind Benefits Inc.

2023 JUN 20 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Bind Benefits Inc. (Minneapolis, Minnesota, United States) has been issued patent number 11663670, according to news reporting originating out of Alexandria, Virginia, by NewsRx editors.

The patent’s inventors are Chock, Matthew (Apple Vally, MN, US), Dickey, David (Yvonne, MN, US), Eiden, Glen (Forest Lake, MN, US), Fast, Trevor (San Francisco, CA, US), Miller, Anthony (Minneapolis, MN, US), Wagoner, Shawn (Edina, MN, US), Wiandt, Matthew (Edina, MN, US), Zeaske, Jessica (Minneapolis, MN, US).

This patent was filed on June 23, 2017 and was published online on May 30, 2023.

From the background information supplied by the inventors, news correspondents obtained the following quote: “Insurance companies offer products such as home and life insurance to cover risks against property and injury. Actuaries at the insurance companies analyze various risks in setting the costs of such products. Computer software such as Milliman’s Arius and Triangles on Demand products are used by insurance actuaries to assess various risks.

“Generally, the leading number of each citation number within the drawings indicates a the figure in which that citation number is introduced and/or detailed. As such, a detailed discussion of citation number 101 would be found and/or introduced in FIG. 1. Citation number 201 is introduced in FIG. 2, etc. Any citation and/or reference numbers are not necessarily sequences but rather just example orders that may be rearranged and other orders are contemplated.”

Supplementing the background information on this patent, NewsRx reporters also obtained the inventors’ summary information for this patent: “The Use Determination Risk Coverage Datastructure for On-Demand and Increased Efficiency Coverage Detection and Rebalancing Apparatuses, Methods and Systems (hereinafter “UDRCD”) transforms coverage enrollment request, event signal inputs, via UDRCD components (e.g., ACM, EF, UF, etc. components), into coverage enrollment response, add-in recommendation outputs. The UDRCD components, in various embodiments, implement advantageous features as set forth below.

“Introduction

“In one embodiment, the UDRCD includes Condition-based coverage: Atomization of coverage that is on-demand and based on procedure or condition rather than annual and based on broad service categories. In one implementation, the UDRCD includes on-demand coverage atomization to reduce entry costs for members to gain coverage to truly insurable events (unpredictable, highest dollars claims); allows members to personalize coverage to their needs; presents treatment and/or provider pathway at the time of need providing relevant choices at relevant times. Underwriting is done today by volume in service categories. This is misaligned with individual disease progression and epidemiology. Underwriting on-demand coverage with atomization utilizes different data science tools and methodology. In one implementation, the UDRCD includes a novel combination of atomized design (also includes choice of provider), on demand coverage at time of need, and structure of the plan. In one implementation, on-demand insurance may include: atomization of plan coverage; attaching insurance coverage to the atomic components; ability to make continuous insurance decisions to make relevant choices at a relevant time, instead of once per year. In typical annual health insurance none of this atomization exists because coverage choices are made long before health care needs are known.

“In another embodiment, the UDRCD includes condition-based coverage: identification of care and coverage need; offer for coverage to patient/member; payment for the coverage. In one implementation, the UDRCD includes processes to identify who should get coverage, what coverage they should get, how they should get it, how it should be priced, and how they should pay for it. In one implementation, the UDRCD includes an Early Listening System (ELS) that determines the event that has occurred and where to direct that event to determine coverage. The ELS is able to understand events from electronic health information (e.g., HL7) data such as encounter data and orders, health care Electronic Data Interchange (EDI) X12 transactions, consumer app and website actions such as search. In one implementation, the ELS informs a recommendation engine which presents condition-specific coverage information. In another implementation, the ELS and the recommendation engine may be implemented in a component and collectively referred to as ELS.

“In another embodiment, the UDRCD’s On Demand Customized Coverage is different than any other system in the U.S. marketplace at this time. UDRCD increases the processing around efficiency and resource use (e.g., providing best value) for members so that good health outcomes are achieved and inappropriate data processing around treatments is reduced and ultimately eliminated. Through efficiencies around the data processing components of the UDRCD, the system provides alternative approaches to reimbursement, and engages patients and providers, providing options never before available in healthcare.”

The claims supplied by the inventors are:

“1. A coverage enrollment facilitating apparatus, comprising: at least one memory; a component collection in the at least one memory; at least one processor disposed in communication with the at least one memory, the at least one processor executing processor-executable instructions from the component collection, the component collection storage structured with processor-executable comprising: obtain, via at least one processor, a coverage enrollment request from a user; determine, via at least one processor, a plan sponsor associated with the user; retrieve, via at least one processor, plan sponsor settings associated with the plan sponsor and the user, in which the plan sponsor settings include atomized condition classification settings, atomized procedure classification settings, and subsidization settings; structure, via at least one processor, available options for an enrollment user interface based on the plan sponsor settings; obtain, via the enrollment user interface, copay setting selections for individual core coverage services, from the available options, of the user; obtain, via the enrollment user interface, atomized medical condition add-in selections, from the available options, of the user; obtain, via the enrollment user interface, atomized medical procedure add-in selections, from the available options, of the user; generate an associated combinational medical plan data structure based on the plan sponsor settings and the obtained copay setting selections, atomized medical condition add-in selections, and atomized medical procedure add-in selections; calculate, via at least one processor, a core coverage cost using the associated combinational medical plan data structure; calculate, via at least one processor, add-in coverage costs, for each of the selected atomized medical condition add-in and each of the selected atomized medical procedure add-in, using the associated combinational medical plan data structure; calculate, via at least one processor, a user cost for the user based on the core coverage cost, the subsidization settings for the core coverage cost, the add-in coverage costs, and the subsidization settings for the add-in coverage costs; and modify, via at least one processor, the enrollment user interface based on the user selections to display the calculated user cost for the user; obtain, via the enrollment user interface, a user selection of a plan, wherein the user selected plan comprises at least one of: a Personal Protection Plan (PPP), wherein the PPP is a data structure comprising fields for: a coverage amount, a pointer to usage, an estimated usage, a goal, an entity of coverage, and a person of coverage, and/or a Health Reimbursement Account (HRA), wherein the HRA is a data structure comprising fields for: a novel coverage, a demand, and a reimbursement; and store, in the component collection storage, the plan selected by the user.

“2. The apparatus of claim 1, further comprising: facilitate, via at least one processor, enrollment of the user into a plan that includes the core coverage, and add-ins coverage for the selected atomized medical condition add-ins and the selected atomized medical procedure add-ins.

“3. The apparatus of claim 2, further comprising: facilitate, via at least one processor, enrollment of the user into additional add-ins at any time during a plan term associated with the plan.

“4. The apparatus of claim 1, in which the plan sponsor settings include available plan terms.

“5. The apparatus of claim 4, in which a plan term is any of: days, weeks, months, yearly, multi-yearly.

“6. The apparatus of claim 4, in which the associated combinational medical plan data structure is determined based on a plan term selected by the user from the available plan terms.

“7. The apparatus of claim 1, in which the plan sponsor settings include available provider networks.

“8. The apparatus of claim 7, in which the associated combinational medical plan data structure is determined based on a set of provider networks selected by the user from the available provider networks.

“9. The apparatus of claim 1, in which the subsidization settings specify a first subsidization amount or percentage for the core coverage and a second subsidization amount or percentage for add-ins coverage.

“10. The apparatus of claim 1, in which the subsidization settings specify an individual subsidization amount or percentage for each add-in.

“11. The apparatus of claim 1, in which the available options associated with an atomized medical condition add-in include a plurality of available procedure options.

“12. The apparatus of claim 1, in which the available options associated with an atomized medical procedure add-in include a plurality of available provider options.

“13. The apparatus of claim 12, in which the available provider options are determined based on proximity of providers to the user’s location.

“14. The apparatus of claim 1, in which a coverage cost associated with an atomized medical condition add-in is calculated based on disease progression probabilities associated with a corresponding atomized condition.

“15. The apparatus of claim 1, in which the user cost is a pay period deduction.

“16. A facilitating coverage enrollment process, including processing processor-executable instructions via at least one processor from a component collection stored in at least one memory, the component collection storage structured with processor-executable instructions, comprising: obtaining, via at least one processor, a coverage enrollment request from a user; determining, via at least one processor, a plan sponsor associated with the user; retrieving, via at least one processor, plan sponsor settings associated with the plan sponsor and the user, in which the plan sponsor settings include atomized condition classification settings, atomized procedure classification settings, and subsidization settings; structuring, via at least one processor, available options for an enrollment user interface based on the plan sponsor settings; obtaining, via the enrollment user interface, copay setting selections for individual core coverage services, from the available options, of the user; obtaining, via the enrollment user interface, atomized medical condition add-in selections, from the available options, of the user; obtaining, via the enrollment user interface, atomized medical procedure add-in selections, from the available options, of the user; generating an associated combinational medical plan data structure based on the plan sponsor settings and the obtained copay setting selections, atomized medical condition add-in selections, and atomized medical procedure add-in selections; calculating, via at least one processor, a core coverage cost using the associated combinational medical plan data structure; calculating, via at least one processor, add-in coverage costs, for each of the selected atomized medical condition add-in and each of the selected atomized medical procedure add-in, using the associated combinational medical plan data structure; calculating, via at least one processor, a user cost for the user based on the core coverage cost, the subsidization settings for the core coverage cost, the add-in coverage costs, and the subsidization settings for the add-in coverage costs; and structuring, via at least one processor, the enrollment user interface to display the calculated user cost for the user; obtain, via the enrollment user interface, a user selection of a plan, wherein the user selected plan comprises at least one of: a Personal Protection Plan (PPP), wherein the PPP is a data structure comprising fields for: a coverage amount, a pointer to usage, an estimated usage, a goal, an entity of coverage, and a person of coverage, and/or a Health Reimbursement Account (HRA), wherein the HRA is a data structure comprising fields for: a novel coverage, a demand, and a reimbursement; and store, in the component collection storage, the plan selected by the user.”

For the URL and additional information on this patent, see: Chock, Matthew. Use determination risk coverage datastructure for on-demand and increased efficiency coverage detection and rebalancing apparatuses, methods and systems. U.S. Patent Number 11663670, filed June 23, 2017, and published online on May 30, 2023. Patent URL (for desktop use only): https://ppubs.uspto.gov/pubwebapp/external.html?q=(11663670)&db=USPAT&type=ids

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