[pc86]

I can only speak of physician's offices but I would imagine the process is much the same in hospitals, if more bureaucratic.

Before a test or lab is ordered, or before a specialist visit is scheduled, one of the assistants needs to verify that your insurance will actually cover the procedure. Typically this means the assistant needs to call the insurance provider, give them your information and what procedure(s) they are checking on.

Insurers provide this data but there are close to a dozen disparate standards and formats. Eligible consolidates all that into a REST API that developers can build applications on top of. From what I can tell this is definitely not for the healthcare industry, but for our industry to build healthcare applications.

I have no affiliation with Eligible, but I've been working in healthcare IT for several years, although not at the startup level.