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KR-20260066643-A - Medical expense payment guarantee system and method for private health insurance subscribers

KR20260066643AKR 20260066643 AKR20260066643 AKR 20260066643AKR-20260066643-A

Abstract

The present invention relates to a medical expense payment guarantee system and method for private medical insurance subscribers, comprising a hospital server, a credit card company server, a payment intermediary server, and an insurance company server. The present invention collects a patient's medical expenses via credit card, settles the insurance proceeds paid by the insurance company by receiving them into a virtual account of the payment intermediary server, and significantly reduces the credit card fees paid by the medical institution to the credit card company by canceling the credit card payment approval for the previously collected medical expenses.

Inventors

  • 박용남

Assignees

  • 박용남

Dates

Publication Date
20260512
Application Date
20251104
Priority Date
20241104

Claims (20)

  1. In the medical expense payment guarantee system for private health insurance subscribers, A hospital server (100) that reads credit card identification data for the payment of a patient's medical expenses, transmits card approval request information including credit card identification data and payment details to a card company server (200), receives payment approval completion information from the card company server (200), transmits medical expense collection information generated through medical expenses to a collection intermediary server (300), receives medical expense payment information corresponding to the medical expense receipt amount included in the medical expense collection information from the collection intermediary server (300), and transmits card approval cancellation information canceling the payment approval completion information to the card company server (200); A card company server (200) that verifies the validity of credit card identification data included in the above card approval request information to generate payment approval completion information, updates the credit card identification data stored in the card company DB (210), and transmits the payment approval completion information to the hospital server (100); and when receiving card approval cancellation information from the hospital server (100), updates the credit card identification data indexed from the card company DB (210) and cancels the previously approved payment approval details in response to the payment approval completion information; A payment brokerage server (300) that receives the above medical fee payment information, opens a virtual account corresponding to the patient identification number, generates insurance claim information corresponding to the medical fee receipt amount and transmits it to the insurance company server (400), receives insurance payment information corresponding to the patient identification number from the insurance company server (400), and transmits the generated medical fee payment information to the hospital server (100); and A medical expense payment guarantee system for a private medical insurance subscriber, characterized by including: an insurance company server (400) that, when insurance claim information received from the above-mentioned payment brokerage server (300) corresponds to patient identification data already stored in the insurance claim DB (410), generates insurance payment information corresponding to the amount of medical expenses included in the insurance claim information and transmits it to the above-mentioned payment brokerage server (300), and stores and manages the generated insurance payment information so as to correspond to patient identification data already stored in the insurance claim DB (410).
  2. In paragraph 1, The above hospital server (100) is, A card information reading module (110) that reads credit card identification data from a patient's credit card (10) and authorizes card approval request information including credit card identification data and payment details to a hospital server transmission module (130); A medical fee collection module (120) that receives payment approval completion information from the hospital server transmission module (130), generates medical fee collection information including a medical fee receipt, and authorizes it to the hospital server transmission module (130); and receives payment information corresponding to the medical fee collection information from the hospital server transmission module (130), collects and settles medical fees excluding service fees, and authorizes card approval cancellation information generated to the hospital server transmission module (130); and A medical expense payment guarantee system for a private medical insurance subscriber, characterized by including: a hospital server transmission module (130) that transmits the above card approval request information to a card company server (200) to authorize the received payment approval completion information to the medical expense collection module (120), transmits the medical expense collection information authorized by the medical expense collection module (120) to a collection intermediary server (300) to authorize the received medical expense payment information to the medical expense collection module (120), and transmits the card approval cancellation information authorized by the medical expense collection module (120) to the card company server (200).
  3. In paragraph 1, The above card company server (200) is, A medical expense payment guarantee system for a private medical insurance subscriber, characterized by generating payment approval completion information through validation that determines whether the credit card identification data received from the hospital server (100) and the credit card identification data already stored in the card company DB (210) match each other, and determines whether the payment details included in the card approval request information are within the card limit details linked to the credit card identification data already stored in the card company DB (210).
  4. In paragraph 1, The above medical expense receipt amount is, A medical expense payment guarantee system for private medical insurance subscribers, characterized by including medical treatment receipts, prescription receipts, and medication receipts for each of the above patient identification numbers.
  5. In paragraph 1, The above-mentioned collection brokerage server (300) is, A brokerage server transmission module (310) that receives medical fee payment information including a patient's identification number from the hospital server (100), authorizes it to the payment brokerage management module (320), transmits the insurance claim information authorized by the payment brokerage management module (320) to the insurance company server (400), authorizes the received insurance payment information to the payment brokerage management module (320), and transmits the medical fee payment information authorized by the insurance management module (330) to the hospital server (100); A payment brokerage management module (320) that receives authorization for the above medical fee payment information, opens a virtual account corresponding to the patient identification number, generates insurance claim information for claiming insurance benefits for medical fees incurred due to the patient's treatment so as to be linked to the opened virtual account, authorizes the above brokerage server transmission module (310), and stores and manages the above insurance payment information in the opened virtual account; and A medical expense payment guarantee system for a private medical insurance subscriber, characterized by including: an insurance payment management module (330) that generates medical expense payment information including an amount obtained by deducting a service fee from the amount included in the insurance payment information indexed from the above payment brokerage management module (320) and authorizes it to the above brokerage server transmission module (310).
  6. In paragraph 1, An AI analysis server (500) that receives advance payment request information including a patient identification number, subscribed private medical insurance information, and a medical expense receipt amount from the above-mentioned payment brokerage server (300), and calculates optimal loan conditions or insurance claim receivable underwriting conditions by comprehensively analyzing the patient's personal credit information, insurance contract details, possibility of insurance payout, estimated insurance payout amount, and medical information through AI big data analysis; and A medical expense payment guarantee system for a private medical insurance subscriber, further comprising: a financial server (600) that receives condition information calculated from the AI analysis server (500), pays a loan to a patient or assumes an insurance claim receivable according to the condition, and automatically receives repayment of the loan or settles the receivable when the actual insurance payment is made from the insurance company server (400).
  7. In paragraph 6, The above AI analysis server (500) is, A credit information collection module (510) that collects personal credit information including the patient's credit rating, income level, debt status, and delinquency history from a credit rating agency based on the patient identification number; An insurance information analysis module (520) that collects and analyzes the coverage scope, insurance amount, insurance type, and insurance claim history of the private medical insurance subscribed to by the patient from the above-mentioned insurance company server (400) or insurance claim DB (410); A medical information analysis module (530) that collects medical information including a patient's diagnosis, surgery name, expected treatment period, and past medical history from the above hospital server (100), and analyzes statistical data including the insurance claim approval rate, average amount of insurance payout, and average period of insurance payout for the relevant disease or surgery; An AI evaluation module (540) that predicts the likelihood of a patient receiving insurance benefits, the expected timing of insurance benefit payments, and the expected amount of insurance benefits to be paid through an artificial intelligence machine learning algorithm based on data collected from the above credit information collection module (510), insurance information analysis module (520), and medical information analysis module (530); and A medical expense payment guarantee system for a private medical insurance subscriber, characterized by including: a condition calculation module (550) that calculates optimal conditions including the loan amount, interest rate, fee, repayment period, and repayment method of a loan or insurance claim acquisition amount to be provided to the patient based on the prediction results of the AI evaluation module (540).
  8. In Paragraph 7, The above condition calculation module (550) is, A medical expense payment guarantee system for private medical insurance subscribers, characterized by setting a loanable amount within a predetermined range of the expected insurance payout amount and optimizing the interest rate by considering the expected timing of the insurance payout.
  9. In paragraph 6, The above financial server (600) is, A medical expense payment guarantee system for a private medical insurance subscriber, characterized by receiving a consent form for the transfer of the right to receive insurance money from the patient via electronic signature before the loan is disbursed, requesting the insurance company server (400) to change the insurance money receiving account to an account designated by the financial server (600), or linking with the collection brokerage server (300) so that the loan is automatically repaid when the insurance money is deposited into the patient's virtual account.
  10. Regarding methods for guaranteeing payment of medical expenses for private medical insurance subscribers, (a) A step in which a hospital server (100) reads credit card identification data and transmits card approval request information including credit card identification data and payment details to a card company server (200); (b) a step in which the card company server (200) transmits payment approval completion information generated by verifying the validity of credit card identification data included in the card approval request information to the hospital server (100); (c) A step in which the hospital server (100) receives the payment approval completion information, generates medical fee collection information including medical expenses incurred according to the patient's treatment, and transmits it to the collection intermediary server (300); (d) A step in which the above payment brokerage server (300) receives the medical fee payment information, opens a virtual account corresponding to the patient identification number, generates insurance claim information corresponding to the medical fee receipt amount, and transmits it to the insurance company server (400); (e) A step in which the above payment brokerage server (300) receives insurance payment information corresponding to a patient identification number from the insurance company server (400) and transmits the generated medical payment settlement information to the above hospital server (100); (f) a step in which the hospital server (100) receives payment information for medical expenses from the payment brokerage server (300) and transmits card approval cancellation information to the card company server (200) to cancel the payment approval completion information; and (g) A step in which the card company server (200) receives card approval cancellation information from the hospital server (100) and cancels the previously approved payment approval details in response to the payment approval completion information; characterized by including a method for guaranteeing payment of medical expenses for a private medical insurance subscriber.
  11. In Paragraph 10, The above step (a) is, (a-1) A step in which the card information reading module (110) of the hospital server (100) reads credit card identification data for payment of medical expenses from the patient's credit card (10) and authorizes it to the hospital server transmission module (130); and (a-2) A method for guaranteeing payment of medical expenses for a private medical insurance subscriber, characterized by including the step of the hospital server transmission module (130) of the hospital server (100) transmitting card approval request information to the card company server (200).
  12. In Paragraph 10, The above step (b) is, (b-1) A step in which the card company server (200) receives card approval request information from the hospital server (100); (b-2) A step in which the above card company server (200) verifies the validity of credit card identification data included in the card approval request information and generates payment approval completion information; and (b-3) A step in which the above card company server (200) updates the credit card identification data stored in the card company DB (210) and transmits the generated payment approval completion information to the hospital server (100); characterized by including a method for guaranteeing payment of medical expenses for a private medical insurance subscriber.
  13. In Paragraph 10, The above step (c) is, (c-1) A step in which the hospital server transmission module (130) of the hospital server (100) authorizes the payment approval completion information received from the card company server (200) to the medical fee collection module (120); (c-2) A step in which the medical fee collection module (120) of the above hospital server (100) receives payment approval completion information, settles the costs incurred according to the patient's medical treatment and examination, and generates medical fee collection information including a medical fee receipt; and (c-3) A step in which the hospital server transmission module (130) of the hospital server (100) transmits medical fee collection information authorized by the medical fee collection module (120) to the collection brokerage server (300); characterized by including a method for guaranteeing payment of medical fees for a private medical insurance subscriber.
  14. In Paragraph 10, The above step (d) is, (d-1) A step in which the mediation server transmission module (310) of the above-mentioned payment mediation server (300) receives medical fee payment information including a patient's identification number from the above-mentioned hospital server (100) and authorizes it to the payment mediation management module (320); (d-2) A step in which the payment brokerage management module (320) of the payment brokerage server (300) opens a virtual account corresponding to a patient identification number, generates insurance claim information for claiming insurance benefits for medical expenses incurred due to the patient's treatment so as to be linked to the opened virtual account, and authorizes it to the brokerage server transmission module (310); and (d-3) A step in which the intermediary server transmission module (310) of the above-mentioned collection intermediary server (300) transmits insurance claim information authorized by the collection intermediary management module (320) to the above-mentioned insurance company server (400); characterized by including a method for guaranteeing payment of medical expenses for a private medical insurance subscriber.
  15. In Paragraph 10, The above step (e) is, (e-1) A step in which the brokerage server transmission module (310) of the above-mentioned collection brokerage server (300) authorizes the insurance payout information received from the above-mentioned insurance company server (400) to the collection brokerage management module (320); (e-2) A step in which the collection brokerage management module (320) of the collection brokerage server (300) stores and manages insurance payment information authorized by the brokerage server transmission module (310) in an established virtual account; (e-3) A step in which the insurance payment management module (330) of the above-mentioned payment brokerage server (300) generates medical payment settlement information including an amount obtained by subtracting a service fee from the amount included in the insurance payment information indexed from the payment brokerage management module (320) and authorizes it to the brokerage server transmission module (310); and (e-4) A step in which the intermediary server transmission module (310) of the above-mentioned payment intermediary server (300) transmits the medical fee payment information authorized by the insurance payment management module (330) to the above-mentioned hospital server (100); characterized by including a method for guaranteeing payment of medical expenses for a private medical insurance subscriber.
  16. In Paragraph 10, The above (f) step is, (f-1) A step in which the hospital server transmission module (130) of the hospital server (100) authorizes the medical fee payment information received from the payment brokerage server (300) to the medical fee payment module (120); (f-2) A step in which the medical fee collection module (120) of the hospital server (100) receives medical fee payment information corresponding to the medical fee collection information, collects and settles the medical fee excluding the service fee, and authorizes the generated card approval cancellation information to the hospital server transmission module (130); and (f-3) A step in which the hospital server transmission module (130) of the hospital server (100) transmits card approval cancellation information authorized by the medical fee collection module (120) to the card company server (200); characterized by including a method for guaranteeing payment of medical expenses for a private medical insurance subscriber.
  17. In Paragraph 10, After step (d) above and before step (e) above, (h) A step of determining whether the insurance claim information received by the insurance company server (400) from the collection brokerage server (300) corresponds to the patient identification data already stored in the insurance claim DB (410); (i) a step in which, as a result of the judgment in step (h) above, if the received insurance claim information and the patient identification data already stored in the insurance claim DB (410) correspond to each other, the insurance company server (400) generates insurance payment information corresponding to the medical expense receipt amount included in the insurance claim information; and (j) a step of transmitting the insurance payout information generated by the insurance company server (400) to the collection brokerage server (300) and carrying out the procedure in step (f); characterized by including a method for guaranteeing payment of medical expenses for a private medical insurance subscriber.
  18. In Paragraph 10, After step (d) above, (k) When the above payment brokerage server (300) confirms the patient's intention to use the medical expense advance payment service if the patient is enrolled in a fixed-amount insurance and is expected to receive a large amount of insurance money, and if the patient consents, transmits advance payment request information including the patient identification number, information on the enrolled private medical insurance, and the amount of medical expense receipt to the AI analysis server (500); (l) A step in which the AI analysis server (500) collects the patient's personal credit information, insurance contract details, and medical information, predicts the patient's likelihood of receiving insurance benefits, the expected timing of insurance benefit payment, and the expected amount of insurance benefit payment through AI big data analysis, and calculates the optimal loan conditions or insurance claim receivable underwriting conditions; (m) A step in which the AI analysis server (500) transmits the calculated condition information to the financial server (600); (n) A step in which the financial server (600) presents the calculated condition information to the patient through the payment brokerage server (300), and if the patient agrees to the conditions, receives a consent form for the transfer of the right to receive insurance money from the patient in the form of an electronic signature; (o) A step in which the financial server (600) pays the loan amount or the insurance claim receivable acquisition amount to the patient's virtual account or the hospital server (100), and the hospital server (100) settles it as medical expenses; (p) A step of setting up so that when the financial server (600) requests a change of the insurance payout receiving account to the insurance company server (400) or links with the collection brokerage server (300) to automatically repay the loan or settle the debt when the insurance payout is deposited into the patient's virtual account; (q) A step in which the insurance company server (400) reviews the patient's insurance claim, approves the payment of the insurance, and pays the insurance to a designated account; (r) A step in which the financial server (600) confirms receipt of insurance money, and if there is a balance after deducting the loan principal, interest, and fees, pays the balance to the patient's account; and (s) A method for guaranteeing payment of medical expenses for a private medical insurance subscriber, further comprising the step of the above-mentioned collection brokerage server (300) receiving information on the completion of loan repayment from the above-mentioned financial server (600) and transmitting information on the completion of medical expense settlement to the above-mentioned hospital server (100).
  19. In Paragraph 18, The above (l) step is, (l-1) A step in which the credit information collection module (510) of the AI analysis server (500) collects the patient's personal credit information from a credit rating agency based on the patient identification number; (1-2) A step in which the insurance information analysis module (520) of the AI analysis server (500) collects and analyzes the coverage scope, insurance amount, and insurance type of the private medical insurance subscribed to by the patient from the insurance company server (400) or the insurance payout DB (410); (1-3) A medical information analysis module (530) of the AI analysis server (500) collects medical information including the patient's diagnosis, surgery name, and expected treatment period from the hospital server (100), and analyzes statistical data including the insurance claim approval rate and the average amount of insurance payout for the disease or surgery; (l-4) A step in which the AI evaluation module (540) of the AI analysis server (500) predicts the likelihood of a patient receiving insurance benefits, the expected timing of insurance benefit payment, and the expected amount of insurance benefit payment through an artificial intelligence machine learning algorithm based on collected data; and (1-5) A method for guaranteeing payment of medical expenses for a private medical insurance subscriber, characterized by including the step of the condition calculation module (550) of the AI analysis server (500) calculating the optimal conditions for a loan or an insurance claim receivable acquisition amount to be provided to the patient based on the prediction results of the AI evaluation module (540).
  20. In Paragraph 19, In the above (l-5) step, The above condition calculation module (550) is characterized by setting a loanable amount within a predetermined range of the expected amount of insurance payout and optimizing the interest rate by considering the expected timing of the insurance payout, in a method for guaranteeing payment of medical expenses for a private medical insurance subscriber.

Description

Medical expense payment guarantee system and method for private health insurance subscribers The present invention relates to a medical expense payment guarantee system and method for private medical insurance subscribers, and more specifically, to a medical expense payment guarantee system and method for private medical insurance subscribers that provides a medical expense collection and settlement service for a patient for whom an insurance claim is scheduled, thereby ultimately settling medical expenses to the maximum extent equivalent to the insurance payout for the private medical insurance subscriber. As consumers' use of credit cards increases, the burden of credit card fees that sellers must pay to card companies continues to rise, and in the case of medical institutions, the credit card usage rate is reaching 70%. For example, in the case of a medical institution with a revenue of 100 billion won, if the credit card usage rate is 70% and the credit card fee rate is 1.5%, the annual cost of credit card fees alone amounts to 1.05 billion won. In other words, in order for the medical institution to achieve a net profit of 1.05 billion won, considering that the hospital's net profit margin is approximately 10%, it must generate approximately 10.5 billion won in new revenue. Meanwhile, as of 2020, 80.6% of all households were enrolled in at least one private medical insurance policy, and among these households, the insurance types consisted of fixed-benefit insurance at 81.0% and indemnity insurance at 40.2%. In other words, the majority of the population was receiving cash reimbursements from insurance companies equivalent to the agreed-upon indemnity insurance amount from medical expenses paid by patients using medical institutions, or, in the case of fixed-benefit insurance subscribers, receiving a lump-sum insurance payment. Particularly for subscribers of indemnity insurance, the current process of medical fee collection by medical institutions and reimbursement by insurance companies operates as follows: after the patient pays the medical expenses via credit card, the medical institution bears the credit card processing fees to the card company; the patient then either claims the insurance directly or utilizes the insurance claim system established at the medical institution, and the insurance company reimburses the patient for the medical expenses in cash. Therefore, as patients pay medical expenses via credit card, the financial burden on medical institutions increases due to the credit card fees borne by the institutions to the card companies, resulting in a growing financial strain. In addition, even patients enrolled in private medical insurance, such as fixed-benefit plans that allow for high disease payouts, often need urgent lump sums of money to pay immediately for high surgery costs, nursing care expenses, etc., before the payout is made. In particular, for patients requiring high surgery costs and long-term care expenses due to cancer or serious diseases, even though they can receive over tens of millions of won in benefits from fixed-benefit insurance, the process of claim review and payment takes weeks to months, resulting in a problem where they cannot secure the funds for immediate medical expenses. These patients face difficulties, such as resorting to high-interest private loans or taking out emergency loans from family and acquaintances. Furthermore, in the case of existing credit or secured loans, evaluations are based solely on the patient's credit rating or collateral value without considering the actual insurance payout to be received, often resulting in insufficient loan limits or loan rejections altogether. This makes it particularly difficult for elderly patients or those with low credit ratings to obtain loans from financial institutions. Figure 1 is an example diagram illustrating the fees that a medical institution pays to a credit card company according to credit card payment. Figure 2 is an example diagram illustrating the scale of medical expenses and the proportion of indemnity insurance. Figure 3 is an example diagram illustrating past medical expense payment and insurance payout methods. FIG. 4 is a configuration diagram illustrating a medical expense payment guarantee system for private medical insurance subscribers according to the present invention. FIG. 5 is a diagram illustrating the relationships between the components of a simplified medical fee collection system according to the present invention. FIG. 6 is a configuration diagram illustrating a hospital server of a simplified medical fee collection system according to the present invention. FIG. 7 is a configuration diagram illustrating a payment brokerage server of a simplified medical fee payment system according to the present invention. FIG. 8 is a flowchart illustrating a method for simplifying the collection of medical expenses according to the present invention. FIG. 9 is a flowchart illustrating t