System And Method For Payment Of Medical Claims

Abstract

A system allows a health care provider to arrange payment at the time of service for a patient responsibility portion of a health care claim amount, even though the provider may not know what the patient responsibility portion will be until after adjudication. A health care debit card is associated with an account of the patient. At the time of service, the patient presents the card to the provider. The provider uses the card to authorize the system to hold an estimate of the patient responsibility amount in suspense in the patient's account. After adjudication, when the actual patient responsibility amount is known, a transaction set is sent to the system. The system then automatically transfers the actual patient responsibility amount from the patent's account and into the provider's bank account. Any remainder of the suspended funds is left in the patient's account. A trace number is provided so that the provider can reconcile bank statement deposits with transaction set information.

Description

CROSS-REFERENCE TO RELATED APPLICATION[0001]This application claims the benefit under 35 U.S.C. §119(e) of U.S. Provisional Application No. 60 / 373,903, filed Apr. 19, 2002. The entirety of the subject matter of U.S. Provisional Application No. 60 / 373,903 is incorporated herein by reference.BACKGROUND INFORMATION[0002]Currently a health care provider (for example, a doctor) does not know at the time of service what portion of the doctor's bill for services will be the patient's responsibility and what portion will be paid by a payer (for example, an insurance company). Only after the patient's visit is the patient responsibility amount determined. This patient responsibility amount is determined by the doctor and the payer in what is called an “adjudication”. This means that the doctor typically cannot bill the patient at the time of service, but rather must wait until the amount is known to bill the patient for the patient responsibility amount. The result is paperwork, administrati...

AI Technical Summary

Benefits of technology

"The patent describes a system and method for making health care payments. The system allows health care providers to accept payment from patients in advance, even if they don't know what the patient's portion of the bill will be. The patient uses a health care debit card to make the payment, which is then held in a designated account. After the service is provided, the provider submits a claim to the patient's insurance company, and the system automatically transfers the funds from the patient's account to the provider's account. The system also provides the transaction set information to the provider, which includes the actual patient responsibility amount and the payer's amount. The provider can confirm that the payment was made by checking the deposit amount in their bank. Overall, the system streamlines the payment process and makes it easier for health care providers to collect funds from patients."

Problems solved by technology

This means that the doctor typically cannot bill the patient at the time of service, but rather must wait until the amount is known to bill the patient for the patient responsibility amount.

The result is paperwork, administrative expense, and a delay in collection.

If the patient later chooses not to pay, the expense to the doctor of collecting payment from the patient may be so great that the doctor elects just to write off the uncollected amount.

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