API's and services like this are Key in making it so that more people will be able to afford medical care. Solving the current cluster F* of paperwork and time involved in establishing eligibility is one of the lowest hanging fruits in cutting medical costs (....NOTE: As opposed to more complicated cost cutting concepts such as preventative care) A typical Doctors office of 2 or 3 practitioners may have 2 or 3 or more support people spending their day faxing back EOB's to insurance companies, etc. Those dollars directly affect the cost of Health Care. This is Great.....X12 is arcane, good riddance. There are actually some insurance clearinghouses that will pay you to use them (if you have high enough volume) as they are paid by the insurance companies and/or through government incentive programs.

So if I'm understanding correctly, the lowest hanging fruit to providing medical care to those in need is...paperwork?

Sounds like we're working on a band-aide, not a solution.

Again, progress is progress. I guess I wonder whether or not these efforts could be focused on the root. I'm probably sounding like a pretentious douche with all the answers...it's not intentional. On a very base level, I cant help but wonder what all this potential could achieve if the focus weren't money. As I understand it, the benefits you proclaim would be a side effect of a successful (read: profitable) implementation.

As always, I might be misunderstanding.

(1) No, I am saying that one of the lowest hanging fruits to drive down the cost of Healthcare is ubiquitous/simple two way electronic communication between providers/payers/patients. Today's technology is more than capable of solving this in a very efficient manner. The politics and other reasons standing in the way of progress is a completely different story. (2) This product is actually a solution to this specific issue (complicated and inaccessible data interchange formats). This is not going to solve the healthcare crisis alone, however I think the net effect of services like this is very positive and will result in lower costs and Better and Faster healthcare service. One Note: While a realitime EOB (explanation of benefits) system will benefit patients. Such a system can be abused. Health Providers that are less than ethical (which hopefully is a small minority) that can more easily query for "un-used" benefits that remain on their patients insurance plan can push un-necessary procedures and diagnostics in order to make more claims.

What your missing is Doctors don't actually cost that much directly. Talking with a doctor for 10 minutes often involves the doctor doing 5 minutes of paperwork, and medical billing people doing 2 hours of work at the doctors office and at your insurance company. The billing people may make 1/3 what the doctor does but if there working 6 times as long there still 2/3's of the costs.

I think it's better for patients to know if they can afford (have coverage) for a treatment before it occurs rather than get a $3000 bill in the mail after it occurs. I know it still sucks ;-/