Method, system, apparatus and computer readable medium for preparing insurance claims for retail activites

• US 20060224443A1
• Filed: 03/16/2005
• Published: 10/05/2006
• Est. Priority Date: 03/16/2005
• Status: Abandoned Application

• Current Assignee: Resolution Health, Inc. (Elevance Health, Inc.)
• Original Assignee: Resolution Health, Inc. (Elevance Health, Inc.)
• Inventors: Benowitz, Gerald, Keehan, Robert, Steinberg, Earl P., Soza, Harry
• Application Number:
  US11/080,618
• Publication Number:
  US 20060224443A1
• Time in Patent Office: Days
• US Class Current: 705/14.170
• CPC Class Codes: G06Q 10/00 Administration; Management
• CPC Class Codes: G06Q 30/0215 Including financial accounts
• CPC Class Codes: G06Q 30/0224 based on user history
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

The present invention is directed to a method, apparatus and computer readable medium for reducing health care costs by creating an incentive for patients to choose the most economical, yet fully effective health care option.

Claims

1. A coupon system for preparing insurance claims for retail activities, relating to first and second products, said first and second products providing substantially the same benefits, and said first product costing less than said second product, comprising:

a coupon that provides a discount to an end user to use said first product, said coupon being provided to said end user as a result of said end user'"'"'s use of said second product so that said end user will use said first product instead of said second product, wherein a third party has a business interest in said user'"'"'s switch from use of said second product to use of said first product.

2. The system of claim 1, wherein said first product is an over-the-counter alternative of said second product, which is a prescription medication.

3. The system of claim 1, wherein said third party is an insurer.

4. The system of claim 1, wherein said coupon includes an identification code.

5. The system of claim 4, further comprising a data compiler to compile data, including said identification code, on said coupon.

6. The system of claim 5, further comprising a second coupon provided in part as a result of said user using said coupon.

7. The system of claim 4, wherein said identification code is a tracking code.

8. The system of claim 1, wherein said coupon is an electronic coupon.

9. The system of claim 1, wherein said coupon is provided by a third party.

10. The system of claim 4, wherein said identification code is used to generate a report of the redemption of said coupon after said coupon is redeemed.

11. The system of claim 10, wherein said report is compatible with an insurance claim system.

12. The system of claim 1, further comprising a deposit into a health savings account in part as a result of said user using said coupon.

13. A coupon system relating to first and second products, which provide substantially the same benefits, comprising:

a coupon for a discount on said first product, which is provided to an end user based on said end user'"'"'s previous purchase history relative to said second product,

a record of the redemption of said coupon,

an insurance claim for said discount linked to said end user.

14. The system of claim 13, wherein said first product is an over-the-counter alternative of said second product, which is a prescription medication.

15. The system of claim 13, wherein said first product is medical equipment.

16. The system of claim 13, wherein said coupon is an electronic coupon.

17. The system of claim 13, wherein said coupon is provided to said end user in conjunction with a report of said user'"'"'s health history.

18. The system of claim 17, wherein said report further includes a review of said user'"'"'s health history for cost-saving possibilities.

19. The system of claim 17, wherein said report further includes a review of said user'"'"'s health history for health improvement possibilities.

20. The system of claim 13, wherein said coupon contains identification information.

21. The system of claim 20, wherein said identification information is a tracking code.

22. The system of claim 20, wherein said insurance claim is a report created from said identification information.

23. The system of claim 22, wherein said insurance claim is compatible with an insurance claim system.

24. The system of claim 20, wherein said identification information can be used by an insurance claim system to track the redemption of said coupon.

25. The system of claim 20, wherein said identification information can be used by a third party to track the redemption of said coupon in order to report the redemption to an insurance claim system.

26. A computer readable medium for preparing insurance claims for retail activities, the computer readable medium having one or more computer modules executable on one or more computer processors, the computer modules carrying out the following acts:

retrieving information about a patient from a memory,

processing said information to identify a first product that was used by said patient,

identifying a second product, where said second product provides substantially the same benefits as said first product, and where the cost of said second product is reduced relative to the cost of said first product,

preparing a coupon for said patient to induce said patient to purchase said second product instead of said first product,

determining whether said patient used said coupon.

27. The medium of claim 26, wherein said coupon is an electronic coupon.

28. The medium of claim 26, further comprising evaluating said patient'"'"'s health history.

29. The medium of claim 28, wherein said patient'"'"'s health history is included in said information about said patient in memory.

30. The medium of claim 28, further comprising preparing a report of said patient'"'"'s health history, and wherein the act of providing further includes preparing a report of said patient'"'"'s health history to said patient.

31. The medium of claim 26, further comprising:

preparing a second coupon for said patient to induce said patient to purchase said first product instead of said second product, where said second coupon is prepared at least in part because said patient used said coupon, and

providing said second coupon to said patient.

32. The medium of claim 26, further comprising:

depositing funds into a health savings account for said patient at least in part because said patient used said coupon.

33. The medium of claim 26, wherein said first product is an over-the-counter medication.

34. The medium of claim 26, wherein said first product is a preferred brand drug.

35. The medium of claim 26, wherein said first product is a generic drug.

36. The medium of claim 26, wherein said first product is medical equipment.

37. The medium of claim 26, further comprising receiving data of said patient'"'"'s health history from a doctor or pharmacy or the patient.

38. The medium of claim 26, wherein said coupon includes information identifying said patient.

39. the medium of claim 26, wherein information regarding the use of said coupon by said patient is added to said information about said patient in memory.

40. The medium of claim 26, wherein said coupon is a tangible coupon which will be manually delivered to said patient.

41. The medium of claim 26, wherein said coupon includes identification information.

42. The medium of claim 41, wherein said identification information is a tracking code.

43. The medium of claim 41, further carrying out the following acts:

receiving information regarding the redemption of said coupon based on said identification information, and

preparing a report on said redemption of said coupon.

44. The medium of claim 43, wherein said report is compatible with an insurance claim system.

45. An apparatus for preparing insurance claims for retail activities, the apparatus comprising:

one or more computer processors that

receive patient information for a first patient,

store said patient information in memory,

evaluate said patient information for the first patient to identify payment for a first product, where said first product has substantially the same effects as a second product, and where the cost of said second product is reduced relative to the cost of said first product, and

prepare a coupon for the first patient, said coupon providing a discount for said second product.

46. The apparatus of claim 45, wherein said one or more computer processors further receive data regarding the use of said coupon.

47. The apparatus of claim 46, wherein said one or more computer processors further evaluate said data, and prepare a second coupon for said first patient, said coupon providing a discount on said first product.

48. The apparatus of claim 47, wherein said one or more computer processors prepare said second coupon because said first patient used said coupon.

49. The apparatus of claim 48, wherein said first patient used said coupon instead of paying for said second product.

50. The apparatus of claim 46, wherein said one or more computer processors further evaluate said data, and deposit funds into a health savings account for said first patient.

51. The apparatus of claim 50, wherein said one or more computer processors deposit said funds because said first patient used said coupon.

52. The apparatus of claim 51, wherein said first patient used said coupon instead of paying for said second product.

53. The apparatus of claim 45, wherein said coupon is an electronic coupon.

54. The apparatus of claim 45, wherein said coupon is a physical coupon.

55. The apparatus of claim 45, wherein said payment for said first product by said first patient did not comprise the full cost of said first product.

56. The apparatus of claim 55, wherein said discount is such that the end cost of said second product after said discount is reduced relative to the portion of said full cost of said first product that was paid by said first patient.

57. The apparatus of claim 45, wherein said coupon contains identification information.

58. The apparatus of claim 57, wherein said identification information is a tracking code.

59. The apparatus of claim 57, wherein said identification information is used to create a report on the redemption of said coupon after said coupon is redeemed.

60. The apparatus of claim 59, wherein said report is compatible with an insurance claim system.

61. a computer readable medium for preparing insurance claims for retail activities, the computer readable medium having one or more computer modules executable on one or more computer processors, the computer modules carrying out the following acts:

receiving information about a coupon, said coupon being prepared specifically for a patient, at least in part as a result of a first health care purchase by said patient, where a second health care purchase provides substantially the same benefits as said first health care purchase, and where the cost of said second health care purchase is reduced relative to the cost of said first health care purchase, and

redeeming said coupon for a discount on said second health care purchase.

62. The medium of claim 61, wherein said coupon is an electronic coupon.

63. The medium of claim 61, wherein said act of redeeming further includes transferring identification information included as part of said coupon.

64. The medium of claim 63, wherein said identification information is a tracking code.

65. The medium of claim 63, wherein said identification information is compiled so that it is compatible with an insurance claim system.

66. The medium of claim 61, wherein said patient only paid a portion of the full cost of said first health care purchase.

67. The medium of claim 66, wherein said discount on said second health care purchase is such that the ultimate cost to said patient for said second health care purchase is reduced relative to said portion of said full cost of said first health care purchase paid by said patient.

68. The medium of claim 61, wherein said second health care purchase is over-the counter medication.

69. The medium of claim 61, wherein said second health care purchase is a preferred brand drug.

70. The medium of claim 61, wherein said second health care purchase is a generic drug.

71. The medium of claim 61, wherein said second health care purchase is medical equipment.

72. a computer readable medium for preparing insurance claims for retail activities, the computer readable medium having one or more computer modules executable on one or more computer processors, the computer modules carrying out the following acts:

receiving information about health care expenses that a patient has incurred,

storing said information in memory,

evaluating said information to determine a recurring health care expense that could be beneficially replaced by an alternate treatment, and

preparing a coupon for said patient for a discount on said alternate treatment.

73. The medium of claim 72, wherein said coupon is an electronic coupon.

74. The medium of claim 72, further comprising evaluating said patient'"'"'s health care expenses.

75. The medium of claim 74, further comprising preparing a report of said patient'"'"'s health care expenses, and wherein the providing step further includes providing a copy of said report of said patient'"'"'s health care expenses to said patient.

76. The medium of claim 72, wherein said first product is an over-the-counter medication.

77. The medium of claim 72, wherein said first product is a preferred brand drug.

78. The medium of claim 72, wherein said first product is a generic drug.

79. The medium of claim 72, wherein said first product is medical equipment.

80. The medium of claim 72, wherein said health care expenses are at least in part paid by an insurer.

81. The medium of claim 72, wherein the computer modules further receive data regarding the use of said coupon.

82. The medium of claim 81, wherein the computer modules further prepare a second coupon in response to said patient using said coupon.

83. The medium of claim 81, wherein the computer modules further deposit funds into a health savings account for said patient in response to said patient using said coupon.

84. The medium of claim 72, wherein said coupon includes identifying information.

85. The medium of claim 84, wherein said identifying information is a tracking code.

86. The medium of claim 84, wherein said identifying information is used to create a report after said coupon is redeemed.

87. The medium of claim 86, wherein said report is compatible with an insurance claim system.

93. The medium of claim 85, wherein said first product is a generic drug.

88. a computer readable medium for increasing sales, the computer readable medium having one or more computer modules executable on one or more computer processors, the computer modules carrying out the following acts:

identifying a user of a first product, where said first product provides substantially the same benefits as a second product, and where the cost of said second product is reduced relative to the cost of said first product,

preparing a coupon for said user to induce said user to purchase said second product instead of said first product,

providing said coupon to said user, and

receiving reimbursement for said coupon from a third-party financer.

89. The medium of claim 88, wherein said coupon is an electronic coupon.

90. The medium of claim 88, wherein said third-party financer is an insurer.

91. The medium of claim 88, wherein said first product is an over-the-counter medication.

92. The medium of claim 88, wherein said first product is a preferred brand drug.

94. The medium of claim 88, wherein said first product is medical equipment.

95. The medium of claim 88, further comprising receiving data of said patient'"'"'s health history from a doctor or pharmacy or the patient.

96. The medium of claim 95, wherein said data of said patient'"'"'s health history is a summary, without identifying said patient.

97. The medium of claim 88, wherein said coupon includes identifying information.

98. The medium of claim 97, wherein said identifying information is a tracking code.

99. The medium of claim 97, wherein said identifying information is used to create a report of redemption of said coupon after said coupon is redeemed.

100. The medium of claim 99, wherein said report is compatible with an insurance claim system.

101. The medium of claim 100, wherein an insurance claims system can use said report to determine whether said user purchased said second product instead of said first product.

102. The medium of claim 99, further carrying out the act of:

depositing funds into a health savings account for said patient in response to use of said coupon for said patient.

103. a computer readable medium for preparing insurance claims for retail activities, the computer readable medium having one or more computer modules executable on one or more computer processors, the computer modules carrying out the following acts:

receiving information about a coupon from a retailer, said coupon prepared for an end user based on a health history for said end user,

reimbursing said retailer for the face value of said coupon,

evaluating data on said coupon indicating said end user who used said coupon,

compiling said data in memory,

creating a report of redemption of said coupon after said coupon is redeemed, said report being compatible with an insurance claim system, and

getting reimbursement for said coupon.

104. The medium of claim 103, wherein said coupon is an electronic coupon.

105. The medium of claim 103, wherein said data on said coupon is an identification number.

106. The medium of claim 103, wherein said data on said coupon is a tracking code.

107. The medium of claim 103, wherein said reimbursement includes payment for said act of evaluating said data on said coupon.