Health care reimbursement

• US 7,617,114 B1
• Filed: 01/30/2003
• Issued: 11/10/2009
• Est. Priority Date: 08/10/2000
• Status: Active Grant

• Current Assignee: Anthem, Inc.
• Original Assignee: Anthem, Inc.
• Inventors: Tooke, Charlton Clinton III, Pomeroy, Charles W., Kronenberg, Douglas M.
• Primary Examiner(s): Gilligan; C. Luke
• Assistant Examiner(s): NGUYEN, TRAN N
• Application Number:
  US10/354,150
• Time in Patent Office: 2,476 Days
• Field of Search: 705/2
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• 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 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: G16H 40/67 for remote operation

Abstract

In general, variations that occur when health care resources are allocated based on dated information may be corrected by receiving a report of a health care transaction to be processed by a health care intermediary administering a health savings account, determining that the health care transaction creates a variation when the health care transaction was initiated based on an indicated status that is different from the actual status of the health savings account, and resolving the variation by interfacing with the health resource provider to correct the variation.

Claims

1. A computer implemented method of administering a health saving account, the method comprising:

contracting by a benefits manager with or for the benefit of an employee to authorize the benefits manager to administer a health savings account for the employee;

contracting by the benefits manager with or for the benefit of the employee and an insurance company to authorize the benefits manager to administer a health insurance policy provided to the employee by the insurance company;

determining a deductible clause for the health insurance policy, wherein the terms of the deductible clause specifies financial responsibility for health expenses incurred by the employee, wherein any amount not responsible for by the health insurance policy would be charged to the employee;

contracting by the benefits manager with one or more health service providers to authorize the benefits manager to receive and adjust any health insurance policy payout prior to forwarding the adjusted payout to the one or more health service providers;

providing electronic communications between the benefits manager, the health insurance company, and the one or more health service providers by each entity having a computer, and the computers interconnected with a network;

in the benefits manager computer, maintaining a balance for the health savings account of the employee;

accepting, by the benefits manager, any contributions made on behalf of the employee and increasing the balance maintained in the benefits manager computer;

storing the deductible clause in the benefits manager computer;

one of the one or more health service providers computers sending a first request to the benefits manager computer over the network for reimbursement for first health services provided to the employee;

comparing, by the benefits manager computer, the first request for reimbursement with the deductible clause to determine financial responsibility for the first health services provided to the employee;

determining, by the benefits manager computer, that the employee is solely responsible for the first health services provided to the employee;

the benefits manager computer deducting the requested reimbursement from the employee'"'"'s health savings account balance, wherein the resulting balance is negative;

the benefits manager computer transferring the deducted reimbursement to the health service provider computer making the first request to effect an electronic funds transfer therefor;

one of the one or more health service providers computer sending a second request to the benefits manager computer over the network for reimbursement for second health services provided to the employee;

comparing, by the benefits manager computer, the second request for reimbursement with the deductible clause to determine financial responsibility for the second health services provided to the employee;

determining, by the benefits manager computer, that the health insurance policy is responsible for covering at least a portion of the second health services provided to the employee;

the benefits manager computer receiving an electronic funds transfer from the insurance company computer to provide reimbursement for the covered portion;

the benefits manager computer deducting at least some of the outstanding negative balance from the amount for reimbursement to compensate for the employee'"'"'s negative balance; and

the benefits manager computer forwarding any remaining funds received from the insurance company computer to the health service provider computer making the second request to pay for the second health services rendered to the employee.

2. The method of claim 1, wherein a payment host computer is provided between the benefits manager computer and the one or more health service provider computers for processing payment transactions therebetween.

3. The method of claim 2, wherein the payment host computer comprises a Pharmacy Benefits Manager processor.

4. The method of claim 1, wherein the employee'"'"'s negative balance is restored by a subsequent infusion into the health savings account.

5. The method of claim 1, wherein the health savings account integrates more than one benefit program.

6. The method of claim 1, wherein the health savings account is a tax favored account or not a tax favored account.

7. The method of claim 1, wherein the health savings account is not a tax favored account.

8. A computer program product for a computer implemented method of administering a health saving account, and including one or more computer readable instructions embedded on a tangible computer readable medium and configured to cause one or more computer processors to perform the steps comprising:

providing electronic communications between a benefits manager, a health insurance company, and one or more health service providers via respective computers interconnected over a network;

in the benefits manager computer, maintaining a balance for a health savings account of an employee;

accepting, by the benefits manager, any contributions made on behalf of the employee and increasing the balance maintained in the benefits manager computer;

storing a deductible clause in the benefits manager computer, wherein the deductible clause is for a health insurance policy for the employee from the health insurance company and the terms of the deductible clause specifies financial responsibility for health expenses incurred by the employee, and any amount not responsible for by the health insurance policy would be charged to the employee;

one of the one or more health service providers computers sending a first request to the benefits manager computer over the network for reimbursement for first health services provided to the employee;

comparing, by the benefits manager computer, the first request for reimbursement with the deductible clause to determine financial responsibility for the first health services provided to the employee;

determining, by the benefits manager computer, that the employee is solely responsible for the first health services provided to the employee;

the benefits manager computer deducting the requested reimbursement from the employee'"'"'s health savings account balance, wherein the resulting balance is negative;

the benefits manager computer transferring the deducted reimbursement to the health service provider computer making the first request to effect an electronic funds transfer therefor;

one of the one or more health service providers computer sending a second request to the benefits manager computer over the network for reimbursement for second health services provided to the employee;

comparing, by the benefits manager computer, the second request for reimbursement with the deductible clause to determine financial responsibility for the second health services provided to the employee;

determining, by the benefits manager computer, that the health insurance policy is responsible for covering at least a portion of the second health services provided to the employee;

the benefits manager computer receiving an electronic funds transfer from the insurance company computer to provide reimbursement for the covered portion;

the benefits manager computer deducting at least some of the outstanding negative balance from the amount for reimbursement to compensate for the employee'"'"'s negative balance; and

the benefits manager computer forwarding any remaining funds received from the insurance company computer to the health service provider computer making the second request to pay for the second health services rendered to the employee.

9. The computer program product of claim 8, wherein a payment host computer is provided between the benefits manager computer and the one or more health service provider computers for processing payment transactions therebetween.

10. The computer program product of claim 9, wherein the payment host computer comprises a Pharmacy Benefits Manager processor.

11. The computer program product of claim 8, wherein the employee'"'"'s negative balance is restored by a subsequent infusion into the health savings account.

12. The computer program product of claim 8, wherein the health savings account integrates more than one benefit program.

13. The computer program product of claim 8, wherein the health savings account is a tax favored account or not a tax favored account.

14. The computer program product of claim 8, wherein the health savings account is not a tax favored account.

15. A computer implemented system for administering a health saving account, the system comprising:

respective computers interconnected over a network for providing electronic communications between a benefits manager, a health insurance company, and one or more health service providers;

the benefits manager computer maintains a balance for a health savings account of the employee;

the benefits manager computer maintains an increased balance to reflect the benefits manager accepting any contributions made on behalf of the employee;

the benefits manager computer stores a deductible clause, wherein the deductible clause is for a health insurance policy for the employee from the health insurance company and the terms of the deductible clause specifies financial responsibility for health expenses incurred by the employee, and any amount not responsible for by the health insurance policy would be charged to the employee;

one of the one or more health service providers computers sends a first request to the benefits manager computer over the network for reimbursement for first health services provided to the employee;

the benefits manager computer compares the first request for reimbursement with the deductible clause to determine financial responsibility for the first health services provided to the employee;

the benefits manager computer determines that the employee is solely responsible for the first health services provided to the employee;

the benefits manager computer deducting the requested reimbursement from the employee'"'"'s health savings account balance, wherein the resulting balance is negative;

the benefits manager computer transfers the deducted reimbursement to the health service provider computer making the first request to effect an electronic funds transfer therefor;

one of the one or more health service providers computer sends a second request to the benefits manager computer over the network for reimbursement for second health services provided to the employee;

the benefits manager computer compares the second request for reimbursement with the deductible clause to determine financial responsibility for the second health services provided to the employee;

the benefits manager computer determines that the health insurance policy is responsible for covering at least a portion of the second health services provided to the employee;

the benefits manager computer receives an electronic funds transfer from the insurance company computer to provide reimbursement for the covered portion;

the benefits manager computer deducts at least some of the outstanding negative balance from the amount for reimbursement to compensate for the employee'"'"'s negative balance; and

the benefits manager computer forwards any remaining funds received from the insurance company computer to the health service provider computer making the second request to pay for the second health services rendered to the employee.

16. The system of claim 15, further comprising a payment host computer provided between the benefits manager computer and the one or more health service provider computers for processing payment transactions therebetween.

17. The system of claim 16, wherein the payment host computer comprises a Pharmacy Benefits Manager processor.

18. The system of claim 16, wherein the employee'"'"'s negative balance is restored by a subsequent infusion into the health savings account.

19. The system of claim 16, wherein the health savings account integrates more than one benefit program.

20. The system of claim 16, wherein the health savings account is a tax favored account or not a tax favored account.

21. The system of claim 16, wherein the health savings account is not a tax favored account.