The IHCEBI message is sent from institutional or individual health care providers or those providing related administrative services to a funding institution to obtain health insurance information from a patient’s health plan prior to or at the time of admission or treatment.

This inquiry message will allow a health care provider to give their patient an estimate of cost for certain treatments, or assess their own financial risk associated with certain treatments, and provide the patient with informed financial choices regarding their health care options.

Each inquiry can provide information to the health plan about a service being considered, (e.g., actual or expected service dates, actual or expected duration of hospital stay, and planned services). An inquiry can also contain information about the treating and referring practitioner, if they are not the health care party making the inquiry.

The response message will provide information regarding what benefits are available to the patient based on their health plan contract and the information provided with the inquiry.  This can include financial information, such as, co-pay amounts, deductible amounts, limitations, and exclusions.

Each response can also provide information regarding administrative issues concerning a covered benefit, such as,indicate who is the primary provider for a service, contact information for the health plan and patient, and policy rules, such as, certain screening exams can only be done once every two years.

This message can only be used with ISO 9735 Version 4 or later.