Patent ID: 8645162

Claim:
A computer implemented method for estimating financial liability of a patient for a medical service to be provided to the patient by a medical service provider, said method comprising: utilizing a computer processor to perform the following steps: accessing a first data set including established payments that medical service providers have agreed to be paid by healthcare coverage entities for providing medical services to individuals; determining if the first data set includes a specific established payment that a medical service provider of the patient has agreed to be paid by a healthcare coverage entity of the patient for a medical service provided to the patient; if the first data set includes the specific established payment, returning the specific established payment for the medical service as an expected payment associated with the medical service; if the first data set does not include the specific established payment, accessing a second data set including historical payments made by healthcare coverage entities to medical service providers for medical services provided to a population of individuals; determining if the second data set includes a first set of specific historical payments that the medical service provider of the patient has been paid by the healthcare coverage entity of the patient for medical services provided to the population of individuals that are similar to the medical service for the patient; if the second data set includes the first set of specific historical payments, estimating the expected payment associated with the medical service for the patient based on the first set of specific historical payments; if the second data set does not include the first set of specific historical payments, estimating the expected payment associated with the medical service for the patient based on a second set of specific historical payments that medical service providers sharing a similar classification as the medical service provider of the patient have been paid by the healthcare coverage entity of the patient for medical services provided to the population of individuals that are similar to the medical service for the patient; further estimating a cost expected to be borne by the patient for incurring the medical service based on the expected payment and based on a set of parameters associated with a healthcare coverage plan of the patient; and presenting financial information that communicates the estimated cost expected to be borne by the patient for incurring the medical service, and an indicator of reliability of that estimated cost.