Automated health benefit processing system

Claim 1

An automated system for processing health benefit claims by an insured patient that indicates the quality of care previously provided by medical service providers, comprising: a database that, for each of a plurality of procedures, specifies a benefit payable in the event the procedure is prescribed and performed, a list of medical service providers available for performing the procedure, each medical service provider's charge for performing the procedure, and for each medical service provider, a quality of service rating list that indicates a prognosis rating versus a recovery rating for previously treated patients; first processing means for generating a treatment plan that specifies the identity of the insured patient and one or more procedures to be performed on the insured and a prognosis rating for the insured patient and for accessing the database to append to the treatment plan the benefit payable, the list of medical service providers and each medical service provider's charge, for each procedure to be performed; second processing means for generating a treatment record that specifies, from the procedures to be performed pursuant to the treatment plan, one or more procedures actually performed on the insured and the actual charge for performing each of the procedures; and third processing means for processing the treatment plan and the treatment record to determine an amount payable to the insured equalling the amount by which the benefit payable for the procedures actually performed less the actual charges for performing the procedures exceeds zero and for determining a recovery rating for the insured patient and for accessing the database to add the insured patient's prognosis rating and recovery rating.