Process for linked healthcare and financial transaction initiation

Abstract

Methods and systems for acquiring a pre-approval from a responsible party and receiving funds from a financial account related to the pre-approval in the healthcare field are described herein. A method for collecting payment from an individual for services rendered by a provider is disclosed. The method includes verifying an individual's eligibility for benefits, estimating an individual responsibility amount, acquiring authority from the individual for up to the individual responsibility amount on at least one financial account held by the individual, submitting one or more claims to one or more payer entities requesting compensation for the services rendered by the provider, deducting an amount from the at least one financial account held by the individual, and transferring the deducted amount to the provider.

What is claimed is: 
     
         1 . A system for collecting payment from an individual for services rendered by a provider, the system comprising:
 a processor; and   a non-transitory, computer-readable storage medium in operable communication with the processor, wherein the storage medium comprises one or more programming instructions, that, when executed, cause the processor to:
 determine an estimated amount for which the individual is responsible for the services rendered by the provider; 
 provide the estimated amount to the individual; 
 transmit one or more claims for adjudication to one or more third party payer entities, wherein the one or more claims comprise a request for compensation for the services rendered by the provider; 
 automatically determine an amount to be deducted from at least one financial account held by the individual based on an amount not paid by the one or more third party payer entities; 
 automatically deduct the determined amount from the at least one financial account held by the individual; and 
 automatically transfer the deducted amount to the provider. 
   
     
     
         2 . The system of  claim 1 , wherein the storage medium further comprises one or more programming instructions, that, when executed, cause the processor to route, via a network, information pertaining to a financial transaction or one or more claims to one or more financial entities housing the at least one financial account held by the individual or the one or more payer entities. 
     
     
         3 . The system of  claim 2 , wherein the storage medium further comprises one or more programming instructions, that, when executed, cause the processor to process, prior to routing, the information in accordance with a Standard Financial Network Authorization Process. 
     
     
         4 . The system of  claim 1 , wherein the storage medium further comprises one or more programming instructions, that, when executed, cause the processor to route, via a service provider, information pertaining to a financial transaction or claim to one or more of the following: a financial entity and a payer entity. 
     
     
         5 . The system of  claim 4 , wherein the storage medium further comprises one or more programming instructions, that, when executed, cause the processor to process the information prior to routing by the service provider. 
     
     
         6 . The system of  claim 1 , wherein the storage medium further comprises one or more programming instructions, that, when executed, cause the processor to route, via a service provider, the information to a network, whereby the information is routed to one or more of the following: a financial entity and a payer entity. 
     
     
         7 . The system of  claim 1 , wherein the one or more programming instructions, that, when executed, cause the processor to determine the estimated amount for which the individual is responsible further comprises one or more programming instructions, that, when executed, cause the processor to acquire eligibility and benefit information from one or more a payer entity, a financial entity, a healthcare provider fee schedule, and a combination thereof, and use the acquired eligibility and benefit information to determine the estimated amount. 
     
     
         8 . The system of  claim 1 , wherein the one or more programming instructions, that, when executed, cause the processor to determine an amount to be deducted from the at least one financial account held by the individual further comprise one or more programming instructions, that, when executed, cause the processor to:
 determine an amount the provider is allowed to charge for the services rendered;   determine an amount the payer entity will compensate the provider for the services rendered; and   determine an amount owed by the individual, wherein the amount owed is a difference between the amount the provider is allowed to charge and the amount the payer entity will compensate the provider, a co-pay, or a combination thereof.   
     
     
         9 . The system of  claim 1 , wherein the provider is a healthcare service provider. 
     
     
         10 . The system of  claim 1 , wherein the financial account is held with a financial entity selected from a financial institution, a bank, a credit card company, a loan company, and a combination thereof. 
     
     
         11 . The system of  claim 1 , wherein the financial account is selected from at least one of a savings account, a checking account, a credit account, a debit account, a credit card account, a debit card account, a health savings account, or a combination thereof. 
     
     
         12 . The system of  claim 1 , wherein each third party payer entity is selected from at least one of a healthcare payer entity, an insurance company, a health savings account, or a combination thereof. 
     
     
         13 . A system for collecting payment from an individual for services rendered by a provider, the system comprising:
 a processor; and   a non-transitory, computer-readable storage medium in operable communication with the processor, wherein the storage medium comprises one or more programming instructions, that, when executed, cause the processor to:
 acquire eligibility and benefit information from one or more of a payer entity, a financial entity, a healthcare provider fee schedule, and a combination thereof; 
 estimate a defined amount of compensation the individual will owe after the payer entity has provided compensation; 
 transmit a claim for adjudication to one or more payer entities, wherein the claim comprises a request for compensation for the services rendered by the provider; 
 automatically determine an amount to be deducted from at least one financial account held by the individual based on an amount not paid by the one or more payer entities; 
 automatically deduct the determined amount from the at least one financial account held by the individual wherein the amount deducted is not more than the defined amount; and 
 automatically transfer the deducted amount to the provider. 
   
     
     
         14 . The system of  claim 13 , wherein the one or more programming instructions, that, when executed, cause the processor to estimate the defined amount of compensation comprises one or more programming instructions, that, when executed, cause the processor to:
 determine an amount the provider is allowed to charge for the services rendered;   determine an amount the one or more payer entities will compensate the provider for the services rendered; and   determine a defined amount owed by the individual, wherein the defined amount owed is a difference between the amount the provider is allowed to charge and the amount the one or more payer entities will compensate the provider, a co-pay, or a combination thereof.   
     
     
         15 . The system of  claim 13 , wherein the storage medium further contains one or more programming instructions, that, when executed, cause the processor to determine a co-pay amount due at a point of service. 
     
     
         16 . The system of  claim 13 , wherein the provider is a healthcare service provider. 
     
     
         17 . The system of  claim 13 , wherein the financial entity is selected from at least one of a financial institution, a bank, a credit card company, a loan company, or a combination thereof. 
     
     
         18 . The system of  claim 13 , wherein the financial account is selected from at least one of a savings account, a checking account, a credit account, a debit account, a credit card account, a debit card account, a health savings account, or a combination thereof. 
     
     
         19 . The system of  claim 13 , wherein the payer entity is selected from a healthcare payer entity, an insurance company, a health savings account, and a combination thereof. 
     
     
         20 . A method of facilitating payment to a provider from an individual comprising:
 determining, by a processor, an estimated amount for which the individual will be responsible for services rendered by the provider;   providing, by the processor, the estimated amount to the individual;   transmitting, by the processor, one or more claims for adjudication to one or more payer entities, wherein the one or more claims comprise a request for compensation;   automatically determining, by the processor, an amount to be deducted from the at least one financial account held by the individual based on an amount not paid by the one or more payer entities;   automatically deducting, by the processor, the determined amount from at least one financial account held by the individual; and   automatically transferring, by the processor, the deducted amount to the provider.