Kerri Marshall, DVM

Darryl Rawlings

Kathryn Plowman

Christopher Cappelletti

Background

Veterinary hospitals provide many medical services during the course of caring for a patient. Pet insurance is one of these many services. Often, patients have health problems that require veterinary care above and beyond what a pet owner is prepared to pay out-of-pocket at the time services are provided, even when they have pet insurance coverage. The pet owner files a claim after leaving the veterinary practice and receives notice of coverage, eligibility and payment, if applicable, from the insurance company. These processes and systems are cumbersome and do not allow a pet owner to rapidly obtain or utilize pet medical insurance.

For the veterinary hospital, existing systems do not provide them with real-time, accurate information about the status of a pet's insurance policy, eligibility of coverage, status of a claim, or facilitate the offering of pet insurance coverage. Most systems are not responsive enough to effectively aid a veterinary practice in managing their practice, frustrating the hospital and the pet owner with the delay.

Additionally, due to the delay in claims processing and the need for the pet owner to cover the expense of medical services at time of service and prior to being reimbursed by the insurance company, the hospital must often provide alternate courses of care that are less expensive, more affordable for pet owners. This is counter-intuitive to the purpose of pet medical insurance coverage.

Thus, it is desirable to provide a pet medical insurance system and method to overcome the above limitations and it is to this end that the disclosure is directed. It is also within the scope of the disclosure to facilitate medical coverage and services at veterinary hospitals outside of pet insurance, such as wellness plans, radiology and lab, and similar services provided at veterinary hospitals utilizing the same system and method implementation. Brief Description of the Drawings

The disclosure will be better understood if reference is made to the accompanying drawings, in which:

Figure 1 is a diagram of an implementation of a pet medical insurance system;

Figure 2 illustrates more details of the pet medical insurance system;

Figure 3 illustrates an example of a user interface of the pet medical insurance system; Figure 4 illustrates a method of interacting with hospital appointment information and providing insurance action options;

Figure 5 illustrates an example of a user interface of appointment data and insurance interaction;

Figure 6 illustrates a method for offering insurance, tracking insurance offers, and providing insurance coverage and eligibility details;

Figure 7 illustrates an example of a user interface for offering pet insurance coverage to a pet owner;

Figures 8 A and 8B illustrate an example of a user interface for tracking insurance offers;

Figure 9 illustrates an example of a user interface displaying the status of a particular pet's medical insurance coverage and eligibility;

Figure 10 illustrates a method for requesting and receiving medical record information; Figures 11 A and 1 IB illustrates an example of a user interface for medical records requests;

Figures 12A and 12B illustrates an example of a user interface for completing medical records requests;

Figure 13 illustrates a method for submitting and processing a claim in the pet insurance system;

Figures 14A and 14B illustrate an example of a user interface for submitting claims in the pet insurance system;

Figure 15 illustrates an example of a user interface indicating claims outcomes; and Figure 16 illustrates an example of a user interface for claims submission and payment tracking. Detailed Description of One or More Embodiments

The disclosure is particularly applicable to a cloud computing 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.

In the disclosure set forth below, a pet owner is a guardian of the pet and could be the pet owner, pet sitter, or similar pet guardian. In the disclosure set forth below, a patient refers to an animal being treated by a veterinary practice. A patient also may be referred to as "pet". In the disclosure below, a veterinary practice refers to a hospital, clinic or similar where services are provided for an animal.

Figure 1 is a diagram of an implementation of pet insurance system (100). The implementation in Figure 1 is cloud computing architecture. However, the system may be implemented in a client/server architecture, a mainframe architecture, a software as a service model and the like, all of which are within the scope of this disclosure. The system may include one or more computing devices (102) and each computing device may be used by a pet owner to connect to and interact with the pet insurance backend component (106) over a communication path (108). The system may also have one or more computing devices (104), such as 104A, 104N and each computing device may be used by (or integrated into) a veterinary practice and allow the veterinary practice to interact with a pet insurance backend component (106) or the 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 data integration agent (200) and a client (201) that interacts with the backend component (106). In one implementation, the data integration agent (200) and the client (201) may be a plurality of lines of code executed by the processor of the computing device. In one

implementation, each of the computing device 102, 104 may have a browser that interacts with the backend component (106), 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, 104.

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 network and the like or any combination thereof 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 HTTP 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 (106 A), online services (106B), a pet insurance management component (106C), and data storage and processing (106D) that are coupled together as shown in Figure 1. The web server (106 A), 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, 104 that is using a browser. The online services— Trupanion Central Services, or TCS— (106B), may be implemented as a plurality of lines of computer code and may generate or exchange information with computing devices 102, 104 directly or through communication path 108 utilizing SignalR, ServiceBus, or similar notification services. The pet 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 processor(s) of the computing resources to implement the pet insurance management functions that are described below in more detail. The data processing and storage device (106D) may be a hardware storage device or a software implemented storage device, such as a database, that stores user and veterinary practice information for the system, stores information about each insurance offer, stores information about each pet that is enrolled in the pet 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 computing device 104 and the backend component 106 and the interactions between the two. As shown the veterinary practice may have one or more browsers/clients (201), a hospital practice information management system (300), and a data integration agent (200). As shown, data from the hospital practice information management system (300) flows into the data integration agent (200) and the data integration agent (200) connects to and communicates with the backend component (106). The data integration agent (200) also connects to and communicates with one or more client/browsers (201) in the computing devices 104. In one implementation, each of the components of the veterinary practice 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 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 inventory tracking, procedure codes, connection to diagnostic equipment and service providers, connection to a variety of radiology modalities and services, and invoice generation.

The data integration agent (200) may be provided by the pet insurance backend system (106) and may be installed in the computing device 104 of the veterinary practice. The data integration agent (200) is a system which integrates with these varied systems to provide added value and operational simplicity for employees of the veterinary practice and pet owners. The data integration agent is responsible for retrieving and mapping data from the PIMS (300), sending communications to and receiving information from Trupanion Central Services (106B) about claim, insurance offers, and enrollments, and communication with the Trupanion Express clients/browsers (201). The data integration agent (200) employs various technological mechanisms to limit traffic between Trupanion Central Services (106B) and Trupanion Express clients/browsers (201), as well as the PIMS (300), creating efficient correspondence between all systems. The data integration agent (200) may include an abstracted engine that allows communication with various PIMS systems on the market today, as well as the ability to integrate with additional in the future in a plug-and-play fashion. The client/browser 200, is the user interface for Trupanion Express. It communicates with the data integration agent (200) and the web UI (106 A) with the aim to exchange information between the hospital and the backend component (106). The client/browser allows submitting claims, issuing insurance offers, searching PIMS data for clients, appointments, mapping clients between systems, and displaying all of the information for these activities in a digestible way for veterinary practice employees— resulting in improved patient care.

The backend component (106) may further comprise a services component (106B), that may be known as Trupanion Central Services, a data storage and processing component (106D), and a pet insurance system(s) (106C), that may be comprised of enrollment and claims systems that are coupled together as shown in Figure 2. Sample data is included in the below table:

Sample Data Exchanged Enrollment Sample Data Claims Sample Data

Between the Veterinary

Practice & Trupanion

Patient demographics Policy ID & type Claims basics Client demographics Policy status Claiming veterinary Claim form information Enrollment veterinary practice information Invoices/estimates practice information Claim outcomes & Medical record Policy coverage amount covered information details Claims payments Insurance offer

information

In one implementation, each of the components of the backend (106) may be a plurality of lines of computer code that are executed by a processor of the computing device 106. The services component (106B) integrates with data storage and processing (106D). The enrollment processing system and claims processing system— pet insurance systems 106C— may interact with the data storage and processing systems (106D) allowing insurance offers to be issued and activated and claims to be processed. The services component (106B) is a service inside

Trupanion' s network and processes requests from and sends information to the data integration agent (200) and passes appropriately formed requests to the data storage & processing systems (106D). The data storage and processing system (106D) is any location where transactional data for Trupanion' s various IT systems is processed and/or stored. The pet insurance system (106C) is comprised of the enrollment processing system, the system that issues insurance offers to pet owners, and the claims processing system, the system that catalogs the collection of medical records that enables claims adjudicators to manage and process pet owner claims. The pet insurance system (100) is revolutionary in that it enables claims to be adjudicated very quickly - allowing the pet owner to not pay out-of-pocket expenses at the veterinary practice. Said another way, the pet insurance system (100) allows Trupanion to pay the veterinary hospital directly with the invoice while the customer is waiting to checkout, similar to the concept of "co-pay" in human health care. The pet insurance system (100) allows for near real-time claims submission and claims processing, enabling claim adjudication at point-of-sale at the veterinary practice. A typical system uses typical channels such as fax or mail that support a delayed reimbursement model for veterinary practices and/or pet owners.

Figure 3 illustrates an example of a user interface 500 of the pet insurance system. The user interface may include a navigation portion (501) that allows the user to navigate around to various parts of the pet insurance system user interface. The user interface may include a status (502) for each pet to indicate the current coverage of that pet. The user interface may further include an action button (503) allowing the user to submit claims or issue an insurance offer to a selected pet. The user interface may have status indicators for current claims transactions (504). The user interface may also have status indicators for current offers of insurance (505).

Figure 4 illustrates a method (600) for determining the current pet insurance coverage for patient with scheduled appointments in the hospital practice information management system (300) and displaying the appropriate action in the pet insurance system user interface (500). Figure 5 illustrates an example of a user interface displaying the appropriate insurance based on the method illustrated in Figure 4.

Figure 6 illustrates a method (700) for obtaining insurance and tracking insurance offers using the pet insurance system and Figure 7 illustrates an example of a user interface for offering pet insurance to a pet owner. The pet insurance system makes it easier for a pet owner to get pet insurance and then quickly be able to have proof of the pet insurance in the form of an insurance offer that can be presented to the veterinary practice to establish the insurance of the pet. In the method (700), a veterinary practice may provide a pet owner an insurance offer (701) which is recorded in Trupanion systems (702) through the data integration agent (200). When the veterinary practice offers the insurance to the pet owner, an employee of the veterinary practice may enter the insurance offer into the client (201), such as shown in Figure 7, and the information about the insurance offer is passed onto the backend component 106 through the data integration agent (200). The pet owner, using a computing device 102, may then activate the insurance offer, and obtain pet insurance, using an email link or by phone which is sent to the backend component 106. Once the pet owner activates the insurance coverage, the pet owner receives proof of insurance which is also passed back to the veterinary practice through the data integration component 200 so that the veterinary practice receives quick notice of the insurance for the pet. In addition, since the computing device 104 and the backend component 106 are integrated as shown in Figure 2, all parties involved are rapidly notified of changes to the pet's insurance coverage. For example, this means the veterinary practice can be comfortable that the pet has insurance for the procedure that is about to be performed. The system may also display the treatment or procedure that is, has been or will be performed on a particular patient or by a particular employee at the veterinary practice.

Figures 8 A and 8B illustrate examples of a user interface for tracking pet insurance offers through the pet insurance system user interface in the client/browser (201) in the veterinary practice. Figure 9 illustrates an example of a user interface of a particular pet's insurance coverage eligibility once the insurance offer has been activated.

Figure 10 illustrates a method (800) for requesting and receiving medical record information used to determine a pet's eligibility for insurance coverage. When the pet insurance system is generating the eligibility the computing device 200 and the pet insurance systems 106C may obtain a history of a pet from any veterinary practice that has seen the pet in the past through the data integration component 200. The pet insurance components (106C) may then structure that data and generate an eligibility of coverage. The system may then display that eligibility of coverage to the users of the system which allows all of the users to rapidly see the coverage status for a pet in a user interface (refer to Figure 9). During the course of collecting medical record information for a pet, it may be required for a hospital to respond directly to requests for information utilizing the user interface of the pet insurance system. Figures 11 A and 1 IB illustrate an example of a user interface for notification of a request for medical records and tracking of medical records requests. Figures 12A and 12B illustrate an example of a user interface for submitting requested records and completing medical records requests.

Figures 13 illustrate a method (900) for submitting and processing a claim in the pet insurance system. Since the backend component and each computing device in the veterinary practice are integrated, as seen in Figure 2, and the system has determined a patient's eligible coverage, an insurance claim may be quickly processed by the claims processing component of the pet insurance component (106C). A claim starts when an employee or doctor of a veterinary hospital completes services for a pet and the veterinary practice submits a claim (see Figure 14A for an example) for the treatment using a claim form (such as shown in Figure 14B) that is generated by the client/browser (201) in combination with the data integration agent (200). The pet insurance company, through the pet insurance systems 106C, may then process the claim. The pet insurance company has the status of the pet's eligibility for coverage and this is able to quickly approve or deny the insurance claim for the pet. If the claim is approved, the claim may be paid directly to the veterinary practice (in one implementation, electronically via ACH) and then the pet owner pays their portion to the veterinary practice. In this manner the system allows a claim to be quickly processed and then paid if the insurance claim is approved.

Figure 15 is an example of a user interface of pet insurance system 100 highlighting display of communication from Trupanion to the veterinary practice claim outcome information.

Figure 16 is an example of a user interface for pet insurance system 100 for tracking of the status of claims submitted and the outcomes and payments for those claims.

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.