Patent Issued for Data processing system for processing network data records transmitted from remote, distributed terminal devices (USPTO 11682477): Sidecar Health Inc.

2023 JUL 11 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- From Alexandria, Virginia, NewsRx journalists report that a patent by the inventors Moulden, Shelby (Long Beach, CA, US), Osetinsky, Veronica (Belmont, CA, US), Quigley, Patrick (Palos Verdes Estates, CA, US), filed on August 19, 2021, was published online on June 20, 2023.

The patent’s assignee for patent number 11682477 is Sidecar Health Inc. (El Segundo, California, United States).

News editors obtained the following quote from the background information supplied by the inventors: “Computer systems can be used to transmit, receive, and/or process data. For instance, a server computer system can be used to receive and store resources (e.g., payment data), and make the content available to one or more client computer systems. Upon receiving a request for the content from a client computer system, the server computer system can retrieve the requested content, and transmit the content to the client computer system to fulfill the request.”

As a supplement to the background information on this patent, NewsRx correspondents also obtained the inventors’ summary information for this patent: “The data processing system allows a consumer to pay a cash rate cost for a health care service. A consumer can purchase a health care service and receive an insurance benefit using a payment card associated with the consumer’s account. The card can include a credit or debit card. This enables a consumer to purchase health care services and receive insurance benefit as if the health care service were any product being purchased with a credit or debit card, where the benefit is applied at the time of purchase at the point of sale device. The health care service provider experiences the purchase as if the purchase were with cash (e.g., cash, credit, or other form of non-insurance payment). The consumer receives the benefit amount according to that consumer’s coverage plan at the time of purchase. Often, purchasing the health care service with cash results in a lower price for the consumer. The data processing system allows the consumer to take advantage of this reduced, cash rate cost while also having insurance benefit pay at least a portion (or substantially all) of the cost.

“The methods of payment and claims by the data processing system provides a simpler alternative to traditional insurance payments and claims processing. In the traditional method, a consumer provides their insurance card at the time of receiving a health care service. After the health care service is received, the health care service provider transmits an invoice, which includes a negotiated cost of the health care service with the particular insurance provider, rather than a cash rate cost. The insurance company remits payment based on a coverage plan for that consumer and sends a bill to the consumer for the remaining balance of the cost which consumer is then responsible for completing payment, often weeks or months after receiving the health care service.

“The data processing system enables the removal of the health insurance company as a middleman between the consumer and the health care service provider for the transaction. Instead, each consumer can pay with a charge card, credit card, or other form of account identifier that identifies the consumer to the point of sale device. Based on the identification of the consumer’s account with the purchase (e.g., because the card or other payment device is linked to the consumer’s insurance account in the data processing system), the data processing system immediately satisfies the cost, and the health care service is paid in full. Because this is preferable to the health care service provider, the health care service provider often offers the health care service at a lower cost if cash is received immediately. The consumer’s account receives the charge, a fixed benefit amount (based on the cash rate cost) is deduced from the cost, and the difference is credited/debited to the consumer’s payment account, either directly or indirectly. If the consumer does not have a direct payment account in the data processing system, the data processing system prompts the consumer to send representation of the bill for the health care service for verification of the cost paid. For example, the consumer can take one or more photos of the receipt from the doctor/medical facility, attach the photo(s) to the expense, and submit the expense to a claims team, all through a user interface. In some implementations, the consumer, having already provided a personal credit card or bank account number when signing up for a plan, is automatically charged for their portion of medical costs. Most payments can be resolved within twenty-four (24) hours.

“A user interface of the data processing system can display various data to the consumer. For example, because the cash rate cost is determined for each health care service, the data processing system is capable of displaying to a consumer exactly how much of a benefit amount is provided for each health care service the consumer uses. In another example, as stated above, through the user interface, the consumer can set a coverage level using an application on a device of the consumer (e.g., during enrollment in an insurance plan). The application shows the consumer, though the user interface, how much each health care service costs, how much coverage costs, and what the benefit is for each health care service.

“Other benefits are also possible. Consumers can use a smartphone application or a web-based application to determine the coverage amount their plan will pay toward a health care service before they see the doctor. They ask the doctor for the cash price of the service, take into consideration the amount their plan will cover, and therefore know the amount they will have to pay out of pocket before obtaining the health care service.”

The claims supplied by the inventors are:

“1. A data processing system configured to process a payment for a health care service that is at least partly covered by a health insurance provider, the data processing system comprising: a data storage configured to: store cash rate data representing cash rate costs paid for health care services for one or more transactions with health care providers; a payment processing engine comprising one or more processors, the payment processing engine configured to: receive transaction data indicating a purchase of a health care service, the transaction data specifying a key value that uniquely identifies a consumer of the health care service; in response to receiving the transaction data, access, from a hardware storage device, a node labeled with the key value; looking-up, in the accessed node, coverage data of the consumer, with the coverage data specifying a payment source for the purchase of the health care; retrieve payment data from the payment source, the payment data specifying a portion of a cost of the health care being paid by the payment source; cause the portion of the cost to be satisfied from the payment source and a remaining portion of the cost to be satisfied from a coverage account; access the data storage to receive the cash rate data associated with the health care; determine a benefit amount of the cost of the health care, the benefit amount of the cost being based on the cash rate costs paid for the health care; and determine a credit or a debit to apply to the payment source by comparing the benefit amount of the cost to the remaining portion of the cost satisfied by the coverage account.

“2. The data processing system of claim 1, wherein the portion of the cost of the health care satisfied by the payment source is none of the cost, and wherein the remaining portion of the cost is a full cost.

“3. The data processing system of claim 1, wherein the payment processing engine is further configured to update the cash rate data associated with the health care in response to receiving the transaction data.

“4. The data processing system of claim 1, wherein the cash rate data comprises, for each health care, a weighted average of a cost for each instance of purchasing the health care in the one or more transactions.

“5. The data processing system of claim 1, wherein the data storage comprises different cash rate data for each geographic region of a plurality of geographic regions associated with the one or more transactions.

“6. The data processing system of claim 1, wherein the benefit amount is adjusted based on one or more demographics of the consumer represented in a profile of the consumer.

“7. The data processing system of claim 1, wherein the benefit amount is adjusted based on a cost coverage setting of a profile of the consumer.

“8. The data processing system of claim 1, wherein the transaction data comprises an identifier representing the health care service.

“9. The data processing system of claim 8, wherein the identifier can be mapped to various standard medical codes.

“10. The data processing system of claim 1, wherein receiving the transaction data comprises: requesting validation data for a point of sale system of the transaction as being associated with an approved health care provider; and in response to receiving the validation data indicating that the health care is approved, enabling the remaining portion of the cost to be satisfied from the coverage account.

“11. The data processing system of claim 1, wherein causing the portion of the cost to be satisfied from the payment source and the remaining portion of the cost to be satisfied from the coverage account satisfies a timeout function of a point of sale system for the purchase of a health care.

“12. The data processing system of claim 1, further comprising a user interface engine configured to generate presentation data for presenting a notice of the credit or the debit on a computing device associated with the consumer.

“13. The data processing system of claim 12, wherein the presentation data comprises the benefit amount for each transaction associated with the consumer.

“14. The data processing system of claim 13, wherein the presentation data is configured to be searchable based on the benefit amount.

“15. The data processing system of claim 12, wherein the payment processing engine is configured to generate additional cost data representing a projected cost or credit associated with each of the one or more transactions, the projected cost or credit being a function of the cash rate data for each of the transactions of the plurality; and wherein the presentation data comprises a representation of the additional cost data.

“16. The data processing system of claim 1, wherein determining the credit or the debit to apply to the payment source comprises: receiving image data representing a medical invoice including the cost for purchasing the health care service; extracting the cost from the image data; and verifying that the cost of the transaction data matches the extracted cost from the image data, wherein determining the credit or the debit to apply to the payment source comprises comparing the extracted cost to the benefit amount.

“17. A method for processing a payment for a health care service that is at least partly covered by a health insurance provider, the method comprising: storing cash rate data representing cash rate costs paid for health care services for one or more transactions with health care providers; receiving transaction data indicating a purchase of a health care service, the transaction data specifying a key value that uniquely identifies a consumer of the health care service; in response to receiving the transaction data, accessing, from a hardware storage device, a node labeled with the key value; looking-up, in the accessed node, coverage data of the consumer, with the coverage data specifying a payment source for the purchase of the health care; retrieving payment data from the payment source, the payment data specifying a portion of a cost of the health care being paid by the payment source; causing the portion of the cost to be satisfied from the payment source and a remaining portion of the cost to be satisfied from a coverage account; accessing the data storage to receive the cash rate data associated with the health care; determining a benefit amount of the cost of the health care, the benefit amount of the cost being based on the cash rate costs paid for the health care; and determining a credit or a debit to apply to the payment source by comparing the benefit amount of the cost to the remaining portion of the cost satisfied by the coverage account.

“18. The method of claim 17, wherein the portion of the cost of the health care satisfied by the payment source is none of the cost, and wherein the remaining portion of the cost is a full cost.

“19. One or more non-transitory computer readable media for processing a payment for a health care service that is at least partly covered by a health insurance provider, the one or more non-transitory computer readable media storing instructions that, when executed by at least one processor, cause the at least one processor to perform operations comprising: storing cash rate data representing cash rate costs paid for health care services for one or more transactions with health care providers; receiving transaction data indicating a purchase of a health care service, the transaction data specifying a key value that uniquely identifies a consumer of the health care service; in response to receiving the transaction data, accessing, from a hardware storage device, a node labeled with the key value; looking-up, in the accessed node, coverage data of the consumer, with the coverage data specifying a payment source for the purchase of the health care; retrieving payment data from the payment source, the payment data specifying a portion of a cost of the health care being paid by the payment source; causing the portion of the cost to be satisfied from the payment source and a remaining portion of the cost to be satisfied from a coverage account; accessing the data storage to receive the cash rate data associated with the health care; determining a benefit amount of the cost of the health care, the benefit amount of the cost being based on the cash rate costs paid for the health care; and determining a credit or a debit to apply to the payment source by comparing the benefit amount of the cost to the remaining portion of the cost satisfied by the coverage account.

“20. The one or more non-transitory computer readable media of claim 19, wherein the portion of the cost of the health care satisfied by the payment source is none of the cost, and wherein the remaining portion of the cost is a full cost.”

For additional information on this patent, see: Moulden, Shelby. Data processing system for processing network data records transmitted from remote, distributed terminal devices. U.S. Patent Number 11682477, filed August 19, 2021, and published online on June 20, 2023. Patent URL (for desktop use only): https://ppubs.uspto.gov/pubwebapp/external.html?q=(11682477)&db=USPAT&type=ids

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