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.
