Researchers Submit Patent Application, “Method And System For Providing A Cognitive Virtual Health And Life Insurance Customer Service Representative”, for Approval (USPTO 20230214933): Patent Application
2023 JUL 24 (NewsRx) -- By a
No assignee for this patent application has been made.
News editors obtained the following quote from the background information supplied by the inventors: “
“Field of the Invention
“The present invention relates to an anthropomorphic, artificial intelligence-based system and method to assist during an underwriting process to enable a consumer to purchase life and health insurance, or benefits products and services (hereinafter “benefits products”) from an insurance benefits provider, benefits company, healthcare discount plan provider, health care sharing ministry, third-party administrator, or similar entities (hereinafter “benefits provider(s)”) and to provide post-enrollment customer services through a cognitive virtual process via phone, mobile device, tablet, app, SMS, chat, iMessage, videoconference, or virtual reality (hereinafter “method(s) of communication”).
“Description of the Related Art
“Consumers of benefits products commonly use comparison shopping internet websites to research and compare available options. benefits broducts comparison shopping websites attempt to guide consumers through intricate product variations from multiple benefits providers. The consumer often struggles to identify adequate affordable coverage and plan options in the marketplace due to a disarray of benefits products ranging from various types (on-exchange, off-exchange, limited indemnity medical, short term medical, ministry, cost sharing), levels of coverage (Platinum, Gold, Silver, Bronze at the federal level), premiums, co-pays, membership fees, deductibles, and limitations. A state of asymmetric information for products across the individual marketplace exists and potentially leads the consumer to adverse selection. In addition, it is often difficult for the consumer to easily understand underwriter requirements and supply required information to the underwriter in order to obtain a benefits product.
“Due to the nature of the chaotic environment, the individual marketplace is also an outlet for fraudulent benefits products. In many cases, consumers seek the assistance of a licensed insurance agent, producer or broker (hereinafter “agent”) to select a benefits product. It is common in the individual marketplace for a consumer to speak with an agent by phone to review available benefits product options and complete the benefits provider’s enrollment process. The agent typically enters the consumer’s underwriting details into a rate quoting calculator or web form to obtain rates, explains the differences between plan options from various benefits providers, and transcribes the enrollment details onto the Benefits Provider’s application or enrollment portal on behalf of the consumer.
“In many cases, the agent is appointed to represent a limited number of benefits providers thus limiting the consumer’s choices to only plans offered by those benefits providers. Compensation arrangements for agents also typically include commissions (a percentage of premium as paid by the benefits provider) or another form of compensation (e.g., marketing fees). Agent bias, thus, is also potentially a significant factor in adverse selection.
“Conventional systems have been used for extracting user data to identify available insurance plans based on responses from the consumer.
“It is desirable to provide an unbiased, anthropomorphic, artificial intelligence-based telephonic system and method to assist in providing underwriter requirements, identify the consumer’s available coverage options based on eligibility, assist in the comparison of different options, automatically enroll the consumer into selected plans based on the provided underwriting, as well as to provide post-enrollment customer services such as identifying and modifying benefits product coverage details and to interface with covered service providers such as pharmacies and physicians.”
As a supplement to the background information on this patent application, NewsRx correspondents also obtained the inventors’ summary information for this patent application: “The present invention relates to an anthropomorphic, artificial intelligence-based system and method to provide benefits product field underwriting and post-enrollment customer services through a cognitive virtual process via a chosen method of communication. In one embodiment, the present invention can automate the tasks of a field underwriter of a benefits provider or the invention can provide a customer service session as initiated by either a member, insured, or policyholder (hereinafter “member”) or initiated by the system.
“In one embodiment, an underwriting session is initiated by the system via a chosen method of communication. The user can be either the proposed member (hereinafter “applicant”) or a system. For a voice session, audio interfaces of the system allow multi-language, bi-directional, speech-based conversations between the cognitive virtual assistant and the user. As the user speaks to the cognitive virtual assistant, a process of automated speech recognition (ASR) can digitally convert received audible speech into transcribed text. Through natural language processing, including sentiment and tone analysis, the system evaluates the meaning and context of the transcribed text and adjusts the language and tone of responses from the cognitive virtual assistant accordingly to accommodate the user. The context-switching capability of the system allows the user to interrupt and restart any embedded process while retaining the user’s information. The system can include an episodic memory to allow the cognitive virtual assistant to recall details from previous segments of the current conversation or previous conversations altogether. The cognitive virtual assistant can be implemented in a conversational manner for receiving information from a user and generating responses using cognitive learning abilities during the conversation. The cognitive learning abilities of the cognitive virtual assistant can also include analytic memory for understanding trend of data, affective memory for understanding emotion and deep back projection networks (DBPN) for learning process flows via empirical learning. The cognitive virtual assistant can be considered to be a “trusted” virtual underwriter as compared to a human prone to error or bias.
“In one embodiment, once a session is initiated, the user is introduced to the cognitive virtual assistant trained to provide information to satisfy requirements noted by the benefits provider during the application underwriting process. It is typical in benefits product underwriting for a benefits provider to require additional information from the applicant following the submission of an application for the selected benefits product. Requirements may include, but are not limited to, medical records, laboratory results, prescribed medications, chronic conditions, family medical history, drug use, and the like.
“In one embodiment, a session is initiated to generate rate quotes and compare available coverage options. In another embodiment, after the underwriting requirements are satisfied, the cognitive assistant can guide the user to complete the application process in order to enroll the applicant into selected plans available from various benefits providers. The cognitive virtual assistant follows a roadmap embedded in a semantic memory for guiding the user through the session. It allows the cognitive virtual assistant to engage in social conversation with the user while focusing the conversation to insurance underwriting requirements, rate quoting, comparison shopping, and enrollment topics and processes.
“The cognitive virtual assistant can prompt the user to answer a series of questions directed to underwriting requirements for a selected benefits product proposal. In one embodiment, the cognitive virtual assistant can also prompt the user to answer a series of pre-qualifying questions to determine available coverage options. In one embodiment, in order to generate a quote of an individual to list rates and details for coverage options for an applicant, the virtual cognitive assistant can request the following information from the user: date of birth, zip code and gender.
“Responses from the user are stored in the memory of the system. The system can invoke an application programming interface (API) to call to one or more third-party benefits providers to obtain pending underwriting requirements and record responses from the applicant to advance the underwriting process. Responses from the one or more benefits provider’s underwriting servers can contain underwriting requirements, including, for example, medical records, laboratory results, prescribed medications, chronic conditions, family medical history, drug use and limitations. The cognitive virtual assistant can review the received responses and relay the received responses or a subset of the received responses to the user by various methods of communication at the user’s preference.
“In addition to the underwriting requirements, the system can also invoke an API call to one or more third-party benefits providerapplication servers to obtain benefits product application requirements for the selected coverage options. The cognitive virtual assistant prompts the user to provide information directed to the application requirements for the selected coverage option. Responses from the user can be stored in memory while collecting information from the user for each data field required on the application for the selected coverage option. Upon satisfaction of the application requirements and underwriting requirements for the selected coverage options, the system invokes an API call to one or more third-party benefits provider enrollment servers corresponding to the one or more third-party benefits provider application servers to submit the application and obtain a policy identification (ID). It will be appreciated that in some embodiments the third-party benefits provider application server can be the same server as the third-party benefits provider enrollment server. The response from the third-party benefits provider enrollment server can contain additional fulfillment material from the benefits provider for the user to be covered. The system can relay the additional fulfillment material to the user by various methods of communication at the user’s preference. The cognitive virtual assistant can also present relevant cross-sell opportunities to the user.
“In one embodiment, the system can also invoke an application programming interface (API) to contact to one or more third-party benefits provider rate quoting servers before the underwriting process to obtain available coverage options from benefits providers for the quoted applicant. Responses from the one or more benefits provider rate quoting servers can contain rate quoting details, including, for example, plan descriptions, premiums and limitations. The cognitive virtual assistant can review the received responses and relay the received responses or a subset of the received responses to the user by various methods of communication at the user’s preference. The system can utilize underwriting guidelines from benefits providers together with user stated preferences, eligibility and affordability to sort and highlight recommended coverage options to the user. The user can select one or more plans from the coverage options and proceed to underwriting, enrollment/policy issuance. The one or more plans can be selected by specifying the one or more plan names or unique identifiers to the cognitive virtual assistant. The system can provide security of the user interface and transmitted data. In one embodiment, data encryption can be used during transport of data.
“In one embodiment, the system and method can automate the tasks of a customer service representative of a benefits provider or a third-party administrator (TPA) working on behalf of benefits provider is provided. A customer service session can be initiated by either a member or by the system via a chosen method of communication. For a voice session, audio interfaces of the system allow multi-language, bi-directional, speech-based conversations between the cognitive virtual assistant and the user. As the user speaks to the cognitive virtual assistant, a process of automated speech recognition (ASR) can digitally convert received audible speech into transcribed text. Through natural language processing, including sentiment and tone analysis, the system evaluates the meaning and context of the transcribed text and adjusts the language and tone of responses from the cognitive virtual assistant accordingly to accommodate the user. The context-switching capability of the system allows the user to interrupt and restart any embedded process while retaining the user’s information. The system’s episodic memory allows the cognitive virtual assistant to recall details from previous segments of the current conversation or previous conversations altogether. The cognitive virtual assistant can be implemented in a conversational manner for receiving information from a user and generating responses using cognitive learning abilities during the conversation. The cognitive learning abilities of the cognitive virtual assistant can also include analytic memory for understanding trend of data, affective memory for understanding emotion and deep back projection networks (DBPN) for learning process flows via empirical learning. The cognitive virtual assistant can be considered to be a “trusted” virtual service representative.”
There is additional summary information. Please visit full patent to read further.”
The claims supplied by the inventors are:
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“18. A computer-implemented method comprising the steps of: a. providing a user interface to a cognitive virtual assistant, the cognitive virtual assistant receives audio from the user interface which is interpreted with artificial intelligence at a processor to generate data and audio responses, the audio responses being forwarded to the user interface; b. the cognitive virtual assistant prompts a user for information directed to one or more existing benefits products of which the user is currently a member; c. identifying coverage information of the one or more benefits products of one or more benefits providers; and d. presenting the coverage information to the user using the cognitive assistant in real time.
“19. The method of claim 18 wherein the step of identifying coverage information can include invoking an application programming interface (API) to call the one or more third-benefits providers to obtain information directed to proof of coverage of the one or more benefits products, coverage details of the one or more benefits products, or to locate a benefits provider.
“20. The method of claim 18 wherein the coverage details include plan descriptions, premiums and limitations and a subset of the coverage details is presented to the user with the cognitive virtual assistant.
“21. The method of claim 18 wherein before step b. further comprising the steps of selecting to modify coverage or enroll in one or more benefits products using the cognitive virtual assistant.
“22. The method of claim 18 wherein to enroll in one or more benefits products is selected and further comprising the steps of: communicating with the one or more benefits providers of selected benefits products to receive application requirements; the user, completing the application requirements using the cognitive virtual assistant; communicating the completed application requirements to a respective one or more benefits providers for enrollment; and receiving enrolled policy information and presenting the enrolled policy information to the user using the cognitive virtual assistant.
“23. The method of claim 18 wherein after step d. further comprising the steps of: the user selecting pharmacy services with the cognitive virtual assistant; communicating with a third party provider of the selected pharmacy services; the cognitive virtual assistant prompting the user to provide information directed to the pharmacy services; communicating with the third party provider of the selected pharmacy services to submit the information directed to the pharmacy service; and presenting information received from the third party provider of the selected pharmacy services to the user using the cognitive virtual assistant.
“24. The method of claim 18 wherein after step d. further comprising the steps of: the user selecting medical services with the cognitive virtual assistant; communicating using the cognitive virtual assistant with a third party provider of the selected medical services; the cognitive virtual assistant prompting the user to provide information directed to the selected medical services; communicating with the third party provider of the selected medical services to submit the information directed to the medical service; and presenting information received from the third party provider of the selected medical services to the user using the virtual cognitive virtual assistant.
“25. A computer implemented system comprising: a user interface communicating with a cognitive virtual assistant, and the cognitive virtual assistant receives audio from the user interface which is interpreted with artificial intelligence at a processor to generate data and audio responses, the audio responses being forwarded to the user interface; a server communicating over a network to the cognitive virtual assistant; and a benefits providers interface communicating with the cognitive virtual assistant, wherein the cognitive virtual assistant prompts a user for information directed to one or more existing benefits products of which the user is currently a member; the server identifies coverage information of the one or more benefits products of one or more benefits providers; and presents. the coverage information to the user using the cognitive virtual assistant in real time.
“26. The system of claim 25 wherein the user interface is an electronic device of a mobile device, cell phone or smart phone.
“27. The system of claim 25 wherein the cognitive virtual assistant has cognitive learning abilities.
“28. The system of claim 25 wherein the cognitive virtual assistant is determined based on a natural language parser.
“29. The system of claim 25 wherein parameters of the cognitive virtual assistant are adjusted to accommodate the user.
“30. The system of claim 25 further comprising a third party pharmacy data interface, the cognitive virtual assistant prompts the user for information directed to selected pharmacy services, the server communicates with a third party provider of the selected pharmacy services to submit the information directed to the pharmacy service and presents information received from the third party provider of the selected pharmacy services to the user using the cognitive virtual assistant.
“31. The system of claim 25 further comprising a third party medical provider data interface, the cognitive virtual assistant prompts the user for information directed to selected medical services, the server communicates with a third party provider of the selected medical services to submit the information directed to the medical services and presents information received from the third party provider of the selected medical services to the user using the cognitive virtual assistant.
“32. The system of claim 25 wherein a API on the server or the cognitive virtual assistant is activated to establish a connection with a API of the benefits provider interface.
“33. The system of claim 30 wherein a API on the server or the cognitive virtual assistant is activated to establish a connection with a API of the third party pharmacy provider interface.
“34. The system of claim 31 wherein a API on the server or the cognitive virtual assistant is activated to establish a connection with a API of the third party pharmacy provider interface.
“35. A non-transitory computer-readable medium having stored thereon a plurality of sequences of instructions, said instructions including sequences of instructions which, when executed by at least one processor, cause said processor to receive audio from a user interface in communication with a cognitive virtual assistant, and the cognitive virtual assistant receives the audio from the user interface, the audio is interpreted with artificial intelligence at a processor to generate data and audio responses, the audio responses being forwarded to the user interface; the cognitive virtual assistant communicating with a benefits providers interface, wherein the cognitive virtual assistant prompts a user for information directed to one or more existing benefits products of which the user is currently a member; the processor identifies coverage information of the one or more benefits products of one or more benefits providers; and presents. the coverage information to the user using the cognitive virtual assistant in real time.
“36. The non-transitory computer-readable medium of claim 35 wherein a API of the cognitive virtual assistant is activated to establish a connection with a API of the benefits providers interface.
“37. The non-transitory computer-readable medium of claim 35 further comprising a third party pharmacy data interface, the cognitive virtual assistant prompts the user for information directed to selected pharmacy services, the processor communicates with a 3rd party provider of the selected pharmacy services to submit the information directed to the pharmacy service and presents information received from the third party provider of the selected pharmacy services to the user using the cognitive virtual assistant.
“38. The non-transitory computer-readable medium of claim 37 wherein a API of the cognitive virtual assistant is activated to establish a connection with a API of the third party pharmacy data interface.
“39. The non-transitory computer-readable medium of claim 37 further comprising a third party medical provider data interface, the cognitive virtual assistant prompts the user for information directed to selected medical services, the server communicates with a 3rd party provider of the selected medical services to submit the information directed to the medical services and presents information received from the third party provider of the selected medical services to the user using the cognitive virtual assistant.
“40. The non-transitory computer-readable medium of claim 39 wherein a API of the cognitive virtual assistant is activated to establish a connection with a API of the third party medical provider interface.”
For additional information on this patent application, see: COHEN, SETH; Silvestre, Luis. Method And System For Providing A Cognitive Virtual Health And Life Insurance Customer Service Representative.
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Studies in the Area of Public Health Reported from Harvard University (Socioeconomic and geographic variation in coverage of health insurance across India): Health and Medicine – Public Health
Patent Issued for Display tool (USPTO 11693872): The Prudential Insurance Company of America
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