Predicting Out-Of-Pocket Expense for a Patient

Abstract

Embodiments of computer-methods and computer systems for predicting out-of-pocket expense for a patient are disclosed. One computer-method includes obtaining claims data and provider data and grouping the claims data into priceable units. A server computes prices for each of the priceable units based on the claims data and the provider data. The priceable units are collected into bundled services as required for predicting the out-of-pocket expense of an episode. Attributes of a health plan of the patient are applied, and an out-of-pocket calculator predicts the out-of-pocket expense based on the collected priceable units and the computed prices for the collected priceable units. The out-of-pocket expense is communicated to patient through a network.

1 . A computer-method of predicting out-of-pocket expense for a patient, comprising:
 obtaining claims data and provider data;   grouping the claims data into priceable units;   computing, by a server, prices for each of the priceable units based on the claims data and the provider data;   collecting the priceable units into bundled services as required for predicting the out-of-pocket expense of an episode;   applying attributes of a health plan of the patient;   predicting, by an out-of-pocket calculator, the out-of-pocket expense based on the collected priceable units and he computed prices for the collected priceable units;   communicating, through a network, the out-of-pocket expense to the patient.   
     
     
         2 . The computer-method of  claim 1 , further comprising synthesizing additional priceable units. 
     
     
         3 . The computer-method of  claim 2 , wherein additional priceable units are synthesized to fill an array, wherein a size of the array is selectable, and wherein the size of the array is dependent on a number of providers and a number of procedures. 
     
     
         4 . The computer-method of  claim 2 , wherein additional priceable units are synthesized in real-time as required to predict at least one of the provider negotiated rate or an out-of-pocket expense. 
     
     
         5 . The computer-method of  claim 2 , wherein synthesizing additional priceable units comprises creating data based on health care knowledge. 
     
     
         6 . The computer-method of  claim 2 , wherein synthesizing additional priceable units comprises predicting data based on knowledge of similar providers. 
     
     
         7 . The computer-method of  claim 1 , wherein computing prices comprises correlating providers having similarities. 
     
     
         8 . The computer-method of  claim 7 , wherein the similarities comprise at least similar pricing schedules, similar geographies, or shared practices. 
     
     
         9 . The computer-method of  claim 1 , wherein obtaining the claims data comprises at least one of normalizing data into a standard format, identifying and rejecting incomplete or erroneous data, identifying instances of reversed or adjusted data, thereby generating a database that contains sanitized, normalized valid claim data. 
     
     
         10 . The computer-method of  claim 1 , wherein obtaining the provider data comprises at least one of normalizing data into a standard format, identifying and rejecting incomplete or erroneous data, thereby generating a database that contains sanitized, normalized valid provider data. 
     
     
         11 . The computer-method of  claim 1 , wherein grouping the claims data comprises parsing the claims data, and collecting claim line items (CLI) of entered claims that are relevant to a particular priceable unit. 
     
     
         12 . The computer-method of  claim 1 , wherein computing prices for the priceable units comprises:
 for each priceable unit, analyzing claim line items (CLI) of the priceable unit.   
     
     
         13 . The computer-method of  claim 1 , wherein computing prices for the priceable units comprises:
 for each priceable unit, applying various techniques on claim line item (CLI) data to determine the price, including at least one of linear regression, logistic regression, Bayesian inference, neural networks, or statistical processes.   
     
     
         14 . The computer-method of  claim 1 , wherein computing prices for the priceable units comprises:
 importing medicare rates or other publicly available rate sheets;   computing each provider's multiplier of an underlying rate sheet; and   computing prices for each provider's priceable units.   
     
     
         15 . The computer-method of  claim 1 , wherein computing prices for the priceable units comprises:
 deducing an underlying rate sheet from multiple providers' claim line item (CLI) using mathematical methods;   computing each provider's multiplier of the underlying rate sheet; and   computing prices for each provider's priceable units based on the provider's multiplier.   
     
     
         16 . The computer-method of  claim 3 , wherein grouping the priceable units into bundled services comprises:
 determining the priceable units within the episode of care in which a cost is being estimated.   
     
     
         17 . The computer-method of  claim 16 , wherein additional priceable units are synthesized to fill an array, wherein a size of the array is selectable. 
     
     
         18 . The computer-method of  claim 16 , wherein additional priceable units are synthesized in real-time as required to predict at least one of the provider negotiated rates or an out-of-pocket expense. 
     
     
         19 . A computer-method for calculating an out-of-pocket medical expense, comprising:
 a patient submitting, through a computing device, an episode of care for expense analysis to a server through a computer network;   sub-dividing, by the server, the episode of care into priceable units;   estimating, by the server, a cost of each priceable unit, comprising;
 obtaining claims data and provider data; 
 grouping the claims data into priceable units; 
 computing, by the server, prices for each of the priceable units based on the claims data and the provider data; 
   estimating the out-of-pocket medical expense of the episode of care based on the priceable unit of the episode of care and the computed price of each of the priceable units;   providing, through the network, the estimate to the computing device of the patient.   
     
     
         20 . A computer-system for calculating an out-of-pocket medical expense, comprising:
 a server, the server connectable to a computing device of a user through a computer network;   the server operative to:   receive an episode of care for expense analysis from the computing device of the user through the network;   sub-divide the episode of care into priceable units;   estimate a cost of each priceable unit, comprising;
 obtaining claims data and provider data; 
 grouping the claims data into priceable units; 
 computing prices for each of the priceable units based on the claims data and the provider data; 
   estimate the out-of-pocket medical expense of the episode of care based on the priceable unit of the episode of care and the computed price of each of the priceable units;   provide, through the network, the estimate to the computing device of the user.   
     
     
         21 . A computer-method of predicting out-of-pocket expense for a patient, comprising:
 receiving negotiated rates from an external source;   assigning or collecting negotiated rates to priceable units;   computing prices for each of the (priceable units based on the negotiated rates;   collecting the priceable units into bundled services as required for predicting the out-of-pocket expense of an episode;   predicting the out-of-pocket expense based on the collected priceable units and the computed prices for the collected priceable units.   
     
     
         22 . A program storage device readable by a machine, tangibly embodying a program of instructions executable by the machine to perform a method of predicting out-of-pocket expense for a patient, comprising;
 obtaining claims data and provider data;   grouping the claims data into priceable units;   computing prices for each of the priceable units based on the claims data and the provider data;   collecting the priceable units into bundled services as required for predicting the out-of-pocket expense of an episode;   applying attributes of a health plan of the patient;   predicting the out-of-pocket expense based on the collected priceable units and the computed prices for the collected priceable units.   
     
     
         23 . A method of enabling a user to search for Out-of-pocket health care costs, comprising:
 obtaining a search term or phrase that is input from the user;   interpreting the user's input;   identifying a health care service or bundle of services the user is interested in based on the user's input;   collecting the priceable units for all providers that provide the services, as filtered by geography, specialty, or other parameters;   calculating the Out-of-Pocket costs for these priceable units.