Pet insurance system and method

PET INSURANCE SYSTEM AND METHOD

Held

Tae disclosure relates generally to a pel insurance system and method.

Background

Pet insurance has existed for a very long time since pets often have health problems 10 that require major surgeries, treatment and the like. However, most current pet insurance systems are very cumbersome and do not allow a pet owner to rapidly obtain the insurance. Furthermore, most of the existing systems do not provide a veterinarian or pet hospital with an easy to view status of any particular pet.so that the veterinary may not know, at the time of a major surgery or treatment, if the pet is going to be covered by insurance which would he 15 desirable. In addition, most existing pet insurance systems take so long to process a claim that both the pet owner and the veterinarian or pet hospital are unhappy with the delay.

Thus, it is desirable to provide a pct insurance system and method that overcomes the above limitations and it is to this end that the disclosure is directed.

Brief Description of the Drawings

Figure I is a diagram of an implémentation of a pet insurance system;

Figure 2 illustrates more details of the pct insurance system;

Figure 3 illustrates an example of a user interface of the pet insurance system;

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Figure 4 illustrates a method for obtaining insurance and certificate tracking using the pet insurance system;

Figure 5 illustrates an example of a user interface for offering a pet insurance certificate to a pct owner:

Figure 6 illustrates a method for determining and displaying a status of a pet to users of the pet insurance system;

Figure 7 illustrates an example of a user interface of the pet insurance system that displays a status of each pet;

Figure 8 illustrates an example of a user interface that displays a set of details of the status of a pet;

Figures 9 A and 9B illustrates examples of user interfaces to view an insurance profile of a pet;

Figure 10 illustrates a method for submitting and processing a claim in the pet insurance system;

Figure 11 illustrates an example of a user interface of submitting a claim in the pet insurance system;

Figure 12 illustrates an example of a claims form in the pet insurance system;

Figure 13 illustrates an example of a claims submission user interface of the pet insurance system; and

Figures 1 4A and 14B are examples of a new claims and claim payment user interface of the pet insurance system.

Detailed Description of One or More Embodiments .1

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-2aAccording to an aspect of die present disclosure, there is provided a system, comprising: a backend component comprising a database system; user computing devices coupled to the backend component over a communication path, each user computing device being configured for use by an owner of a patient and having a processor, and memory storing a plurality of lines of computer code; a plurality of computer systems connected to the backend component over the communication path, each computer system of the plurality of computer systems being at a respective veterinary practice and comprising: a processor; memory; and a practice information management system of the respective veterinary practice having one or more modules for managing the respective veterinary practice; a client in communication with the practice information management system; and a plug-and-play express system connected to the practice information management system and configured for electronic communication with the backend component, wherein the plug-and-play express system retrieves data from the practice information management system, maps the data using an abstraction engine that allows communication with one or more different practice information management systems according to the database system of the backend component and sends the mapped data to the backend component, thereby limiting the data traffic between the backend component and the practice information management system, the plugand-play express system being plug-and-play integratable with one or more different practice information management systems for connection thereto; the backend component further comprising: a processor, and memory storing a plurality of lines of computer code that when executed by the processor causes the backend component to: communicate with the plug-andplay express system of any of the computer systems to request data from the practice information management system of any of the computer systems, the plug-and-play express system of each computer system accessing data from each practice information management system of each veterinary practice, retrieve one or more pieces of data about a patient, via the plug-and-play express system and from the practice information management system of any of the computer systems, and store the one or more pieces of data about the patient; each user computing device of the user computing devices further configured to: communicate with the backend component to request insurance coverage for the patient that is owned by the owner for which the user computer device is configured for use, and receive an insurance offer from

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-2bthe backend component and allow activation of the insurance offer; and the backend component further configured to: receive a request for insurance coverage from any of the user computing devices for a particular patient, generate an insurance coverage, for the particular patient, that is stored in the database system when the insurance offer has been activated, and communicate the insurance coverage for particular patient to a computer system computer system of the plurality of computer systems through the plug-and-play express system of the computer system; each computer system further configured to display an insurance coverage communicated by the backend component as a patient insurance coverage status of the particular patient to the respective veterinary practice of the computer system; and the backend component further configured to: programmatically process a claim for one or more treatments and procedures for the particular patient based on the insurance coverage status of the particular patient, and electronically pay an amount to the respective veterinary practice for the one or more provided treatments and procedures at the time of completion of the one or more provided treatments and procedures.

There is also provided a method using a backend component implemented on a computer, the method comprising: receiving, by a services component of the backend component, from an insurance component used by a veterinary practice that is remote from the backend component, one or more pieces of data about an animal, the veterinary practice comprising one of a plurality of different veterinary practices remote from the backend component; storing the one or more pieces of data about the animal in a database system of the backend component; generating, on one or more computing devices capable of being coupled to the backend component, a request for insurance coverage for the animal; receiving, on the one or more computing devices capable of being coupled to the backend component, an insurance offer from the backend component; mapping data from a practice information management system of the veterinary practice to the insurance component by a plug-and-play express system connected to the practice system and in communication with the backend component, the plug-and-play express system: receiving data from the practice information management system; mapping the data using an abstraction engine that allows communication with one or more different practice information management systems according to the insurance component; and sending the mapped data to the insurance component, thereby

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81791678 delimiting the data traffic between the insurance component and the practice information management system to create efficient correspondence between the insurance component and the practice information management system and improve the enrollment and processing of insurance claims for the animal, the plug-and-play express system being plug-and-play integratable with a practice information management system of a second or more of the plurality of veterinary practices for connection thereto; enrolling, by an enrollment processing component of the backend component, an owner of the animal for the insurance coverage for the animal upon receipt of the request for the insurance coverage for the animal and issuing the insurance offer for the animal; programmatically generating, using a claims processing component of the backend component, an eligibility of insurance coverage for the animal when the insurance offer has been activated by the owner, the eligibility of insurance coverage being stored in the database system; displaying the eligibility of insurance coverage for the animal at the veterinary practice; and programmatically processing, using the claims processing component of the backend component, a claim for a treatment or procedure for the animal, wherein the claim is processed based on the eligibility of insurance coverage of the animal, and paying an amount to the veterinary practice for the treatment or procedure.

Another aspect provides a system comprising: a first veterinary practice information management system of a first veterinary practice having an insurance component, the first veterinary practice information management system comprising one of a plurality of different veterinary practice information management systems of different veterinary practices; a backend component, remote from the veterinary practice information management systems, comprising a processor and a memory storing a database and a plurality of lines of computer code that when executed by the processor causes the backend component to: communicate with the insurance component used by the first veterinary practice information management system over a communications path, receive from the insurance component over the communications path, one or more pieces of data about an animal and store the one or more pieces of data about the animal in the database; one or more user computing devices capable of being coupled to the backend component, each computing device comprising a processor and a memory storing a plurality of lines of computer code that when executed by the processor causes the one or more user computing devices to: communicate with the

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-2dbackend component to request insurance coverage for the animal and receive an insurance offer from the backend component; a computing device at the first veterinary practice having a processor and memory storing a plurality of lines of computer code that when executed by the processor causes a plug-and-play express system of the computing device to: connect to the first veterinary practice information management system of the first veterinary practice and communicate between the first veterinary practice information management system and the backend component; the backend component further configured to receive the request for insurance coverage for the animal, generate the insurance offer, generate an eligibility of insurance coverage for the animal when the insurance offer has been activated and displayed at the first veterinary practice as patient insurance coverage status and displayed at the user computing device as patient insurance coverage status, programmatically process a claim for one or more treatments or procedures for the animal based on the eligibility of insurance coverage of the animal and pay an approved claim amount to the first veterinary practice for the one or more treatments and procedures; the plug-and-play express system connected to the first veterinary practice information management system of the first veterinary practice and configured to communicate with the backend component, the plug-and-play express system configured to receive data from the first veterinary practice information management system, map the data using an abstraction engine that allows communication with one or more different practice information management systems according to the insurance component of the backend component and send the mapped data to the backend component, thereby limiting data traffic between the backend component and the first veterinary practice information management system, the plug-and-play express system being plug-and-play integratable with a second or more of the plurality of different veterinary practice information management systems of the different veterinary practice for connection thereto.

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The disclosure is particularly applicable to a client server 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.

Figure 1 is a diagram of an implementation of a pct insurance system 100. The implementation in Figure 1 is a typical client/server architecture that is described below in more detail. However, the system may also be implemented in a cloud computing architecture, a mainframe architecture, a software as a service mode and the like that are all which are within scope of this disclosure. The system may include one or more computing devices 102, such as 102A,.... 102N, and each computing device 102 may be used by a pet owner to connect to and interact with a pet insurance backend component 106 over a communications path 108. The system may also have one or more computing devices 104, such as 104A,..., 104N, and each computing device 104 may be used (or integrated into) a veterinary practice or pet hospital and allow the veterinary practice or pet hospital to connect to and interact with a pet insurance backend component 106 over a 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 client 200 that interacts with the backend component. In one implementation, the client or browser 200 may be a plurality of lines of computer code executed by the processor of the computing device. In one implementation, each of the computing device 102 may have a browser that interacts with the backend component, 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.

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 .1

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WO 2014/152179 PCT/US2014/027042 network and the like 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 ΙΓΓΓΡ 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, a pet insurance management component 106B and a storage device 110 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 and exchange data with each computing device 102 that is using a browser. The pet insurance management component 106B manages the pet insurance system operations, including enrollment of pet owners, generation and maintenance of a status of each pet in the system, payment and processing of claims from the pet owners and interactions with the veterinary practice or pel hospital. The pel 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 processors) of the computing resources to implement the pet insurance management functions that are described below in more detail. The storage device 110 may be a hardware storage device or a software implemented storage device such as a database, that stores user and veterinary practice or pet hospital information for the system, stores information about each pel that is enrolled in the pel 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 or pet hospital computing device 104 and the backend component 106 and the interactions between the two. As shown, the veterinary practice or pet hospital may have one or more clients 200, a hospital information management system 202 and a pet insurance component 204. As shown, data from the hospital information management system 202 flow into the pet insurance component 204 and the pet insurance component 204 connects to and communicates with the backend component 106 (specifically .1

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WO 2014/152179 PCT/US2014/027042 an enrollment system and a claims processing system) and the pet insurance component 204 connects to and communicates with the one or more clients 200 in the computing devices 104. In one implementation, each of the components of the veterinary practice or pet hospital 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 or pet hospital 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 inventoiy tracking, procedure codes, connection to diagnostic equipment and service providers, connection to a variety of radiology modalities and services and invoice generation.

The pet insurance component 204 may be provided by the pet insurance backend system 106 and may be installed in the computing device 104 of the veterinary practice or pet hospital. The pet insurance component 204, that may be known as the Trupanion Express service (TES), is a system which integrates with these varied systems to provide added value and operational simplicity for both veterinarians and pels. The service component of TES is responsible for retrieving and mapping data from any PIMS, communicating with Trupanion Central Services (TCS) 210 about claims or certificates and communicating with Trupanion Express Client (TREX) 200. TES 204 employs various technological mechanisms to reduce the amount of traffic between TCS and TREX, as well as the PIMS creating efficient correspondence. TES 204 may include an abstracted engine that allows communication with various PIMS systems on market today, as well as the ability to integrate with more in the future in a plug-and-play fashion.

The client 200, that may be known as Trupanion Express Client (TREX), is the user interface for Trupanion Express. It communicates with TES 204 with the aim to exchange information between the hospital and the backend component 106. The client allows submitting claims, issuing certificates, searching PIMS data for pet insurance clients and appointments, mapping clients between systems, and displaying all of the information for these activities in a digestible way for hospital staff. Additionally, TREX 200 is a catalyst for .1

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-6better workflows and communications for hospital staff - resulting in significantly improved patient cane.

The backend component 106 may further comprise a services component 210, that may be known as Trupanion Central Services, the storage device 110, known as Trupanion database system, an enrollment processing system 212 and a claim processing system 214 that are coupled to each other as shown in Figure 2. Sample data is included in the below table:

<td> Sample Data Exchanged Between the Hospital &amp; Trupanion</td><td> Enrollment Sample Data</td><td> Claims Sample Data</td>

<td> • Patient Demographics • Client Demographics • Claim Form Information • Invoices/Estimates • Medical Record Information • Certificates Status</td><td> • Policy ID &amp; Type • Policy Status • Enrollment Clinic Information • Policy Coverage Details</td><td> • Claim Basics • Claiming Clinic Information • Claim Outcomes &amp; Amount Covered</td>

In one implementation, each of the components of the backend component 106 may be a plurality of lines of computer code that are executed by a processor of the computing device 106. The services component 210 integrated with the storage device. The enrollment processing system 212 and a claim processing system 214 may interact with the storage 110 allowing certificates to be issued and activated and claims to be processed. The services component 210 is a service inside Trupanion's network that receives TES requests and passes the appropriately-formed requests on to the Trupanion Database System (TruDat) 110. The Trupanion Database System (TruDat) is any location where transactional data for Trupanion’s various IT systems is stored. The Enrollment Processing System is the system that issues certificates to pet owners interested in potentially becoming a Trupanion policyholder and the claim Processing System (PO) is the system that catalogs the collection of medical records that enables claims adjudicators to manage and process pet owner claims. Trupanion Express is revolutionary in that one of its purposes is to allow claims to be adjudicated very quickly allowing the pet owner to not pay out-of-pocket expenses at the veterinary' hospital. Said another way, Trupanion Express allows Trupanion to pay veterinarians directly with PO while the customer is standing at checkout, similar to the concept of a “co-pay” in human health care. Trupanion Express allows for near real time claims submission and claims processing enabling claim adjudication at point of sale at the veterinary clinic. Versus typical channels .1

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WO 2014/152179 PCT/US2014/027042 such as fax or mail that support a delayed reimbursement model for veterinary practices or pet hospitals and/or pet owners. For additional details, see Claim A.

Figure 3 illustrates an example of a user interface 300 of the pet insurance system. The user interface may include a status bar 302 that shows statistics about the system (enrollments, certificates, claims and claims paid), a pet status portion 304 for each pet that is part of the pet insurance system and a navigation portion 306 that allows the user to navigate around the pet insurance system. The user interface may have are area 308 for each pet wherein that area further has start claim button 310 that allows the pet hospital to start an insurance claim on behalf of the pet owner for the particular pet and a status indicator 312, known as a Paw Print, that indicates a status of the pet within the pet insurance system. The generation of the Paw Print and the information that it conveys is described below in more detail.

Figure 4 illustrates a method 400 for obtaining insurance and certificate tracking using the pet insurance system and Figure 5 illustrates an example of a user interface for offering a pet insurance certificate to a pet owner. The pet insurance system makes it easier for a pet owner to get pet insurance (assuming no pre-existing conditions that prevent it) and then quickly be able to have proof of the pet insurance in the form of a certificate that can be presented to the veterinary practice or pct hospital to establish the insurance of the pct. In the method, a doctor may offer a pet owner a certificate (402) for pet insurance for a particular pet through the express service component 204. When the doctor offers the insurance to the pet owner, a person at the veterinary practice or pet hospital may enter the certificate into the client 200 and the information about the certificate (such as shown in Figure 5) is passed onto the backend component 106 through the Trupanion express service 204. The pet owner, using a computing device 102 may then activate the certificate (and obtain pct insurance) using an email link of by phone which is sent to the backend component 204. Once the pet owner activates the certificate, the pet owner receives the certificate of insurance which is also passed back to the veterinary practice or pet hospital through the express service component 204 so that the veterinary practice or pet hospital receive quick notice of the insurance for the pet. In addition, since the computing device 104 and the backend component 106 are integrated together as shown in Figure 2, everyone involved in the pet insurance is rapidly notified of the insurance. For example, this means that the veterinary .1

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WO 2014/152179 PCT/US2014/027042 practice or pet hospital can be comfortable that the pet has insurance for the procedure that is about to be performed.

In addition to the process above, the system also allows the veterinary practice or pet hospital, when they want to perform a procedure or treatment, to pre-approve a pct for the treatment or procedure using a pre-approval request made through the client 200 and the express service 204 that communicates the pre-approval request to the backend component 106. In this pre-approval, the Paw Print has not been generated for the pet so it is not typically used during the pre-approval process.

Figure 6 illustrates a method 600 for determining and displaying a status of a pet to users of the pet insurance system. When a pet owner is trying to get insurance for a pet or at any other time once the pet is the process of or has obtained insurance, the system displays the status indicator 312 for the pet as shown in Figure 7. The status indicator for each pet may be color coded so that a doctor/employee at the veterinary practice or pet hospital can quickly determine the status of the pet. For example, the status indicator may be a green color indicating that the pet has no pre-existing condition, may be an orange color indicating that the pet does have one or more pre-existing conditions and may be a grey color indicating that the generation of the status indicator is in process for the particular pet. In addition to the status indicator, the user may click on the status identifier and see the additional details about the pet in a user interface like that shown in Figure 8.

Returning to Figure 6, when the pet insurance system is generating the status indicator, the backend component 104 (and the enrollment processing system 212) may obtain a history' of the pet from any veterinary practice or pet hospital that has seen the pet in the past though the Trupanion express service 204 (602). The system may then generate condition codes based on the pet history (604) and then generate the appropriate status indicator (Paw Print) based on the condition codes (606). The system may then display the status indicators to the users of the system (608) which allows all of the users to rapidly see the status for a pet in a user interface. For a veterinary practice or pet hospital, the status indicator allows, for example, the doctor to quickly determine whether or not a to be performed procedure will be covered by the insurance and then make treatment decisions based on the status indicator. Since the backend component 106 and each computing device .1

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104 in each veterinary practice or pet hospital are integrated as shown in Figure 2, the status indicator may be propagated to all of the users of the system quickly.

Figures 9A and 9B illustrates examples of user interfaces to view an insurance profile of a pct. This allows a user of the system (a pct owner or veterinary practice or pct hospital) to quickly view the insurance summary for a pet.

Figure 10 illustrates a method 100 for submitting and processing a claim in the pet insurance system. Since the backend component 106 and each computing device 104 in each veterinary practice or pet hospital are integrated as shown in Figure 2 and the system generate the pet Paw Print which indicated pre-existing conditions that might affect an insurance claim, an insurance claim may be quickly processed by the claim processing portion 214. A claim starts when a doctor treats a pet ( 1002) and the doctor/employee of the doctor creates and submit a claim (see for example Figure 11) for the treatment using a claim form (such as shown in Figure 12) (1004) that is generated by the client 200 in combination with the express service 204. The pet insurance company (through the claim processing system 214) may then process the claim. The pet insurance company has the status of the pet’s health history (based on the Paw Print) already stored in the system and thus is able to quickly approve or deny the insurance claim for the pet (1006.) If the claim is approved, the claim may be paid (1008) directly to the veterinary practice or pet hospital (in one implementation, electronically via ACH) and then the pet owner pays their portion to the pet hospital. In this manner, the system allows a claim to be quickly processed and then paid if the insurance claim is approved.

Figure 13 illustrates an example of a claims submission user interface of the pet insurance system 100 that allows user to see current claims and the status of those claims. Figures 14A and 14B arc examples of a new claims and claim payment user interface of the pet insurance system.

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.