Determination of healthcare coverage using a payment account

• US 8,660,862 B2
• Filed: 05/30/2007
• Issued: 02/25/2014
• Est. Priority Date: 09/20/2005
• Status: Active Grant

• Current Assignee: Visa International Service Association (Visa, Inc.)
• Original Assignee: Visa USA, Inc. (Visa, Inc.)
• Inventors: Patterson, Barbara Elizabeth, Pourfallah, Stacy, Pruitt, Janet, Nguyen, Loc, Smith, Nigel
• Primary Examiner(s): Chang, Edward
• Application Number:
  US11/755,713
• Publication Number:
  US 20080010096A1
• Time in Patent Office: 2,463 Days
• Field of Search: 705/4, 705/35
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

Healthcare insurance coverage is determined using an account within a payment processing system. A transmission addressed to the payment processing system is formed including an account number of an account associated with the payment processing system, a description of a healthcare related commodity rendered to a patient deriving healthcare insurance through an insured, and request for a specification of financial responsibility of the insured for the described said healthcare related commodity. A transmission is received from the payment processing system including the requested specification of financial responsibility.

Claims

1. A processor-implemented method comprising:

receiving account information associated with an insured upon instantiation of a consumer portable device at a healthcare provider financial payment acceptance terminal;

forming, via a processor, at the healthcare provider financial payment acceptance terminal a healthcare coverage eligibility determination request including;

the account information associated with the insured;

a description of a healthcare related commodity for a patient deriving healthcare insurance through the insured; and

a request for a healthcare patient financial responsibility specification for said healthcare related commodity;

transmitting the healthcare coverage eligibility determination request to a payment processing system,

wherein the payment processing system is configured to process card-based financial payment transactions; and

receiving, in response to the healthcare coverage eligibility determination request the requested healthcare patient financial responsibility specification from the payment processing system.

2. The method as defined in claim 1, wherein the the payment processing system corresponds to an entity selected from the group consisting of:

a payment transaction system;

a transaction handler;

an acquirer;

an issuer; and

a combination thereof.

3. The method as defined in claim 1, wherein the insured is the patient.

4. The method as defined in claim 1, wherein the healthcare related commodity is selected from a group consisting of:

a healthcare related good;

a healthcare related service; and

a combination thereof.

5. The method as defined in claim 1, wherein the healthcare related commodity is provided by an entity selected from the group consisting of:

a provider of a healthcare service for compensation by the healthcare insurance of the insured;

a provider of healthcare goods for compensation by the healthcare insurance of the insured; and

a combination thereof.

6. The method as defined in claim 1, wherein the account corresponds to a payment method selected from the group consisting of a credit card, a debit card, a saving account, a checking account, a stored value card account, a gift card account, a money market fund, a trust account, a Flexible Spending Account, a Managed Savings Account, a Dependent Care Reimbursement Account, a Health Care Reimbursement Account, Health Reimbursement Account, and a combination thereof.

7. The method as defined in claim 1, wherein the account information includes an account number for the account.

8. The method as defined in claim 1, the specification of financial responsibility of the insured for the healthcare related commodity includes information selected from the group consisting of:

a healthcare provider identifier for a healthcare provider that has provided the healthcare related commodity to the patient;

a code associated with the healthcare related commodity;

a contracted amount due for the healthcare related commodity;

a textual message conveying the nature of the healthcare related commodity; and

a combination thereof.

9. The method as defined in claim 1, wherein the requested specification of financial responsibility is selected from the group consisting of:

an amount due from the insured for the healthcare related commodity the patient;

an expense of the healthcare related commodity;

a deductible initial portion of a covered expense of the healthcare related commodity, said covered expense being payable by the insured before the insurance thereof pays the residual part of the covered expense;

a remaining portion of the deductible initial portion;

a specification of a percentage of the deductible initial portion;

a remaining value of insurance available to the patient through the insured;

information about insurance available to the patient through the insured; and

a combination thereof.

10. The method as defined in claim 1, wherein the response is received less than about one (1) hour after transmitting the eligibility determination request.

11. The method as defined in claim 1, wherein the request is encrypted.

12. The method as defined in claim 1, wherein the specification of financial responsibility includes an eligibility indication for the patient as to insurance coverage through the insured for the healthcare related commodity.

13. The method as defined in claim 1, wherein the specification of financial responsibility includes an eligibility indication for the patient as to insurance coverage through the insured for the healthcare related commodity, wherein the eligibility indication is selected from the group consisting of:

indicia signifying that the patient is eligible for insurance coverage through the insured for the healthcare related commodity;

indicia signifying that the patient is ineligible for insurance coverage through the insured for the healthcare related commodity; and

indicia signifying that the patient is partially eligible for insurance coverage through the insured for the healthcare related commodity.

14. The method as defined in claim 1, further comprising:

making a payment utilizing the account associated with the insured wherein the payment is at least a portion of the financial responsibility of the insured for the healthcare related commodity.

15. The method as defined in claim 14, wherein:

the account is issued by an issuer;

the payment is for a transaction with a provider of the healthcare related commodity;

the provider of the healthcare related commodity communicates the transaction to an acquirer;

the acquirer communicates the transaction to a transaction handler;

the transaction handler communicates the transaction to the issuer; and

the issuer communicates the transaction to the insured for payment.

16. A processor-implemented method, comprising:

receiving, via a payment processing system, a healthcare coverage eligibility determination request formed at a healthcare provider financial payment acceptance terminal from a healthcare provider including;

an identifier of an account associated with an insured;

a description of a healthcare related commodity for a patient-deriving healthcare insurance-through the insured; and

a request for a healthcare patient financial responsibility specification for the healthcare related commodity;

wherein the payment processing system is configured to process card-based financial payment transactions;

determining, via a processor, an insurance account identifier based at least in part on the identifier of the account, wherein the insurance account identifier is associated with both the insured and its insurance carrier;

transmitting the healthcare coverage eligibility determination request along with the insurance account identifier to the insurance carrier;

receiving a response to the transmitted healthcare coverage eligibility determination request from the insurance carrier, the response including the healthcare patient financial responsibility specification; and

transmitting at least a portion of the response to the health care provider.

17. The method as defined in claim 16, wherein the determining further comprises using an algorithm to convert the identifier of the account to the insurance account identifier associated with the insured.

18. The method as defined in claim 16, wherein the specification of financial responsibility includes an eligibility indication for the patient as to insurance coverage through the insured for the healthcare related commodity.

19. The method as defined in claim 18, wherein the eligibility indication is selected from the group consisting of:

indicia signifying that the patient is eligible for insurance coverage through the insured for the healthcare related commodity;

indicia signifying that the patient is ineligible for insurance coverage through the insured for the healthcare related commodity; and

indicia signifying that the patient is partially eligible for insurance coverage through the insured for the healthcare related commodity.

20. A processor-implemented method, comprising:

receiving account information associated with an insured upon instantiation of a consumer portable device at a healthcare provider financial payment acceptance terminal;

forming, via a processor, at a healthcare provider terminal a healthcare coverage eligibility determination request including;

the account information associated with the insured;

a description of a healthcare related commodity for a patient covered by healthcare insurance through the insured; and

a request for a healthcare patient financial responsibility specification for the healthcare related commodity;

transmitting the healthcare coverage eligibility determination request to a payment processing system,

wherein the payment processing system is configured to process card-based financial payment transactions; and

receiving, a response from the payment processing system the response including the requested healthcare patient financial responsibility specification; and

determining based on the received response from the payment processing system an amount owed by the insured for the healthcare related commodity.

21. The method as defined in claim 20, further comprising:

obtaining at least a portion of the determined amount owed by utilizing the account.