Case Study | Healthcare / Maternal Health
Aeroflow Breastpumps: Insurance Eligibility as Platform Architecture
Insurance logic as platform foundation, not a bolted-on feature.
INDUSTRY
Healthcare / Maternal Health
PLATFORM
Magento
MODEL
B2C with Insurance Automation
FOCUS
Insurance Eligibility & Pricing Control
The architecture decision
Insurance rules belong in your platform, not your support queue
Standard eCommerce assumes simple transactions: customer adds item, enters payment, checkout ends. Insurance-covered healthcare is different. When a customer submits physician and insurance details, three things must happen simultaneously: coverage evaluated against carrier rules, account created with the correct pricing tier locked in, and compliance notices activated only when legally required.
We built this as a unified tier-assignment engine, not a separate verification workflow. At the moment of qualification, the system maps the customer to their insurance group, assigns their pricing tier, and flags applicable compliance rules. This becomes the foundation for everything downstream.
Before this platform, customers faced a friction loop: submit information, wait days for manual verification, receive a phone call, encounter unexpected pricing, see compliance notices they didn’t understand, then abandon or escalate to support.
How it works
Insurance flows through checkout, not around it
Customers submit physician and insurance details once. The platform evaluates coverage in real-time. The moment validation completes, an account is created with the correct pricing tier already assigned – eliminating the multi-day email verification bottleneck.
Once a tier is assigned, pricing stays consistent through every product selection. Insurance-covered pump prices never revert to retail. The platform tracks cumulative claims per pregnancy, preventing duplicate coverage claims and showing actual costs transparently.
What we delivered
Insurance logic built into every layer
Instant qualification and tier assignment
Real-time insurance evaluation against carrier databases and plan tier logic. Account created with correct pricing tier at the moment of qualification. No separate email verification bottleneck.
Insurance-locked pricing
Once a tier is assigned, pricing stays consistent through every product selection. Promotional pricing, wholesale discounts, and plan-specific rebates all activate automatically based on tier.
Contextual compliance notices
ABNs, state-specific disclosures, and plan-based disclaimers only appear when relevant – certain pump models, certain states, certain insurance tiers. Zero compliance friction for customers who don’t need it.
One covered pump enforcement
Tracks cumulative claims per insurance plan and pregnancy. Prevents duplicate claims and shows actual customer cost for a second pump transparently at selection time.
Guided accessory path with progress tracking
Progress indicator shows how many accessories customers have reviewed. Reduces decision fatigue and keeps customers moving instead of abandoning mid-accessory selection.
The bottom line
Insurance logic is the architecture itself.
When qualification, pricing, compliance, and fulfillment all flow from a single tier assignment, you eliminate the manual verification and support escalations that kill conversion in healthcare eCommerce.
Frequently Asked Questions
Customers submit physician and insurance details once. The platform evaluates coverage against carrier databases in real-time and creates an account with the correct pricing tier already assigned. This replaces multi-day manual verification with a 60-second onboarding step.
Contextual compliance – ABNs, state-specific disclosures, and plan-based disclaimers only appear when legally required for that specific customer, state, plan, and product combination. Customers who don’t need notices never see them.
If you sell insurance-covered products and your team is manually processing eligibility, let’s discuss purpose-built architecture.
Ready to build insurance-integrated eCommerce?
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