I'm a physician, and every insurance company to which I submit claims already has a web service in place to check eligibility...at no charge. Already.
There aren't many interface differences between insurance companies: you typically enter two identifiers, usually either an id number or last name, and birth date. You get full eligibility info immediately.
There's nothing difficult about it. We almost never call insurance companies to get eligibility info - web querying is already in place, and has been for a while.
What problem, at 5 cents for each API CALL (c'mon, really?) is this solving? Why would I want to pay to pass my patient's protected health information through yet another layer (and store? see my comment below about this company's offer of a data "sample") of potential privacy loss?
Many many. I just discussed this with our office manger - checking eligibility is not a problem for us (nor would it be for most practices in my opinion) using web services already in place....and especially not free vs a dollar per 20 queries.
I'm not actually a fan of insurance companies, but please explain why I would want to pay for the hassle of dealing with Yet Another third-party and at the same time expose my patient's protected health info to Yet Another layer of risk?
I see. We certainly would not expose your patient's data. My reply at bottom should help clear that up for you. You forgot to mention what specialty you are?
No, actually your reply doesn't describe your security practices at all. Why are you retaining live data at all?
Forgive me, but just claiming "we certainly would not expose your patient's data" is hollow at best - I take the responsibility for protecting my patient's health information very seriously, as do most physicians, and it is ultimately our responsibility to do no harm in that regard.
Not saying this is true of you guys, but there are a lot of incentives out there for "mining" and even selling health info. At the very least, storing health data on multiple, geographically disparate servers, logging access, retention policy, etc is a nightmare waiting to happen.
You forgot to mention what specialty you are? Take a look at our privacy, terms of service, and security pages to answer the rest of your questions above. If you do not think the service is useful then you don't need to use it. That's the beauty of the free market. One man's junk is another man's treasure.
I'm a family medicine doc in a practice with several other docs. Why do you ask?
I already read your site's security pages, which in large measure do NOT address the questions I've asked here.
However, I believe you're right - neither I nor the software folks I consult with here in Bay Area will be interested in using your tool. Good luck to you.
Gotcha, primary care is what I assumed. Most of the insurance company websites will give you back a basic active/inactive response along with the patient's copayment. For primary care docs this is enough (although its still annoying to go to 100+ websites if you accept a lot of insurance plans). However; for surgeons, chiropractors, massage therapists, dentists, diagnostic labs, genetic testing facilities, MRI facilities -- this basic information is not even close to enough. That's where the Eligible API comes in.
I and all physicians and our office staffs get back complete eligibility information for ALL possible care from a single query from existing insurance co queries: eligibility for all surgical, laboratory, radiological, inpatient hospitalization, partial hospitalization, psychiatric care, etc etc; along with deductible, copay, balance, etc etc.
Doctors have to refer patients around - we need to know which specialists accept what insurance and can see our patients. The insurance companies want us to know that. It's in their interest to let us know that. They let us know that. Already.
Could you explain how your query of the insurance company's information would be more complete than the insurance company's query of its own information?
On second thought, go have a nice day. I realize I am asking for technical information and getting sales spiel in return.
No need to get rude here. My replys are sticking to facts not insults. Yes, my experience is in sales and I'm proud of it.
Here's the data most interesting to our existing user base:
1) limitations (ie if the patient only has certain amount of visits per year)
2) deductible remaining
3) co-insurance responsibility
4) health spending balances
5) Coverage for specific tests/equipment/procedures: infertility, blood draws, wigs, durable medical equipment, dental crowns, etc.
Two of our largest api users built the system for: diagnostic lab order entry service and genetic testing service.
I'm a physician, and every insurance company to which I submit claims already has a web service in place to check eligibility...at no charge. Already.
There aren't many interface differences between insurance companies: you typically enter two identifiers, usually either an id number or last name, and birth date. You get full eligibility info immediately.
There's nothing difficult about it. We almost never call insurance companies to get eligibility info - web querying is already in place, and has been for a while.
What problem, at 5 cents for each API CALL (c'mon, really?) is this solving? Why would I want to pay to pass my patient's protected health information through yet another layer (and store? see my comment below about this company's offer of a data "sample") of potential privacy loss?