Medical payment system

• US 8,527,298 B2
• Filed: 06/01/2012
• Issued: 09/03/2013
• Est. Priority Date: 01/08/2002
• Status: Active Grant

• Current Assignee: First Access, Inc. (WEX Inc.)
• Original Assignee: First Access, Inc. (WEX Inc.)
• Inventors: Darling, Kimberly A., Baylor, Dorothy M.
• Primary Examiner(s): Sereboff, Neal
• Application Number:
  US13/486,759
• Publication Number:
  US 20120303380A1
• Time in Patent Office: 459 Days
• Field of Search: 705/2, 705/3, 705/4, 705/410
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 20/102 Bill distribution or payments
• CPC Class Codes: G06Q 20/14 specially adapted for billing systems
• CPC Class Codes: G06Q 40/02 Banking, e.g. interest calculation or account maintenance credit or loans G06Q40/03
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/65 stored on portable record carriers, e.g. on smartcards, RFID tags or CD

Abstract

A medical payment system is described in which a provider of medical goods and/or services submits, via telephone or other communications medium, a request for payment amount determination for a patient encounter. A price determination system determines which of a plurality of fee schedules negotiated by the provider applies to the patient encounter and calculates, based at least in part on information entered by the provider, a payment amount for the encounter, which it communicates to at least the provider. In one embodiment, the provider receives the payment amount information while the patient is at the point of service. In one embodiment, the provider may use the system to submit a claim for payment by at least one responsible party.

Claims

1. A method of facilitating payment of health care benefits to a health care provider comprising:

identifying the healthcare provider that renders goods and services in anticipation of payment;

identifying a payer that has agreed to pay the healthcare provider on behalf of a patient subject to preselected conditions;

determining with computer hardware comprising one or more computer processors, a payment amount with one or more computer processors associated with the goods or services wherein determining the payment amount comprises;

selecting at least one fee schedule from multiple fee schedules based at least in part on the provider identification information; and

calculating the payment amount based at least in part on the selected fee schedule;

verifying that the payment amount is a bona fide medical expense;

sending the verification of the payment amount to an account associated with the patient;

approving, the payment amount only when the verification of the payment amount has been received; and

transmitting a copy of the payment amount to the health care provider.

2. The method of claim 1, wherein the account is a bank account.

3. The method of claim 1, wherein the bank account is associated with a card that is at least one of the group consisting of:

a stored value card, a medical credit card, and a medical plan card.

4. The method of claim 1, further comprising approving multiple payment amounts.

5. The method of claim 1, further comprising receiving and storing multiple payment amounts.

6. The method of claim 1 further comprising processing and storing multiple payment amounts associated with multiple patient encounters.

7. The method of claim 1, further comprising prompting a provider with an interactive voice response system to enter information about a patient encounter.

8. The method of claim 1, wherein the interactive voice response system communicates information about the approval of the payment amount.

9. The method of claim 1, wherein the interactive voice response system communicates information about the account.

10. The method of claim 1, further comprising determining a portion of the payment amount to be paid by the patient and a portion of the payment amount to be paid from a source of medical funds.

11. The method of claim 1, wherein a source of medical funds is a third-party payor.

12. The method of claim 1, wherein a source of medical funds is a flexible savings account.