Method and system of providing medical goods and services to consumers through retail outlets
First Claim
1. A method of providing medical goods and services to consumers through retail outlets, said method comprising the steps of, in combination:
- verifying current eligibility of a consumer for benefits from a health benefit provider for medical goods and services desired by the consumer;
wherein the current eligibility of the consumer is verified while the consumer is present at a retail outlet;
receiving an assignment from the consumer to a benefit manager that assigns all rights to the benefits from the health benefit provider for medical goods dispensed to the consumer;
wherein the retail outlet and the benefit manager are separate entities;
completing and submitting a claim to the health benefit provider for reimbursement for the medical goods dispensed to the consumer;
receiving reimbursement from the health benefit provider for the medical goods dispensed to the consumer; and
making a fixed, periodic payment to the retail outlet for services rendered to the consumer by the retail outlet on behalf of the benefit manager.
1 Assignment
0 Petitions
Accused Products
Abstract
A method of providing medical goods and services to consumers includes the steps of a retail outlet receiving a request for medical goods and services from a consumer who is present at the retail outlet. The retail outlet verifying, through a benefit manager, the consumer'"'"'s current eligibility for health benefits from Medicare or other health insurance provider for the medical goods. The verification is preferably performed over a PBM computer system. An assignment of benefits is obtained from the consumer and transferred to the benefit manager by the retail outlet wherein the consumer assigns his or her rights to Medicare or other health insurance benefits to the benefit manager, including the right to submit a claim for reimbursement and the right to receive payment directly from Medicare or such other health insurance payer for the medical goods and services. If eligible and authorized by a physician'"'"'s order, the retail outlet provides the needed medical goods and services to the consumer. The medical goods dispensed to the consumer by the retail outlet are either owned by the benefit manager, owned by the retail outlet and transferred to the benefit manager just prior to the release of the medical goods to the consumer, or owned by the retail outlet. The benefit manager completes a complicated Medicare claim form and/or other health insurance claim form based on the medical goods and services provided to the consumer, then submits such claim to Medicare and/or the other health insurance payer for reimbursement. If the claim is clean and proper, the benefit manager receives reimbursement from Medicare and/or the other health insurance payer after a period of time. The benefit manager makes a fixed, periodic payment to the retail outlet for services rendered by the retail outlet on behalf of the benefit manager.
37 Citations
24 Claims
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1. A method of providing medical goods and services to consumers through retail outlets, said method comprising the steps of, in combination:
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verifying current eligibility of a consumer for benefits from a health benefit provider for medical goods and services desired by the consumer;
wherein the current eligibility of the consumer is verified while the consumer is present at a retail outlet;
receiving an assignment from the consumer to a benefit manager that assigns all rights to the benefits from the health benefit provider for medical goods dispensed to the consumer;
wherein the retail outlet and the benefit manager are separate entities;
completing and submitting a claim to the health benefit provider for reimbursement for the medical goods dispensed to the consumer;
receiving reimbursement from the health benefit provider for the medical goods dispensed to the consumer; and
making a fixed, periodic payment to the retail outlet for services rendered to the consumer by the retail outlet on behalf of the benefit manager. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13)
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14. A method of providing medical goods and services to consumers comprising the steps of, in combination:
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obtaining eligibility information from a consumer who is presently located at a retail outlet and who desires immediate medical goods and services;
forwarding the eligibility information to a benefit manager for verification of the consumer'"'"'s eligibility for benefits from a health benefit provider for the medical goods and services;
wherein the benefit manager is a separate entity from the retail outlet;
directing the consumer to make an assignment of the benefits to the benefit manager for the medical goods and services;
forwarding evidence of the assignment to the benefit manager; and
receiving from the benefit manager a fixed, periodic payment for services rendered by the retail outlet on behalf of the benefit manager. - View Dependent Claims (15, 16, 17, 18, 19, 20, 21, 22, 23, 24)
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Specification
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- Resources
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Current AssigneeExpress-Med, Inc.
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Original AssigneeExpress-Med, Inc.
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InventorsRudy, Alan T.
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Application NumberUS09/954,939Publication NumberTime in Patent OfficeDaysField of SearchUS Class Current705/4CPC Class CodesG06Q 10/10 Office automation; Time man...G06Q 30/06 Buying, selling or leasing ...G06Q 40/08 InsuranceG16H 40/20 for the management or admin...
