A system and tool that stores and tracks all member healthcare and
prescription expenses, using private and secure Internet accounts
to monitor payments of their Managed Care (HMO/PPO) provider or
insurer. A management tool that has the ability to track and administrate
Health/Medical Saving Accounts and also tell a member based on the
total amount of any expense what they should expect the insurer
to pay and what they (member/insured) should expect to pay towards
that expense. The invention utilizes expense tracking computer software
that automatically alerts members when the insurer has failed to
pay the full amount of medical expenses as required under the medical
insurance policy. The customer service component of the invention
allows the initiation of contact with that member's Managed Care
(HMO/PPO) or insurer to discuss the issue of payment on behalf of
that member. The tool includes the ability to work as an ombudsman
for members with benefit management online with their HMO/PPO, healthcare
provider or employer to work towards positive resolution on expense,
coverage or problem/issues and question for members offering supplemental
or itemized bill review. The tool may include pre-paid legal assistance
when ombudsman services can't resolve a member issues, expenses,
or healthcare needs.
1. A system for monitoring insurance contract payment for health
care expenses comprising: a) enrolling a member in a medical insurance
contract monitoring service; b) inputting insurance contract information
of a health insurer; c) receiving medical event information for
the member; d) evaluating medical event information with the insurance
contract information; e) calculating an insurance contract payment
obligation from the medical event information; and f) communicating
to the member if an insurance payment differs from calculated insurance
2. The system of claim 1 further comprising an application program
performing steps (a) through (f).
3. The system of claim 1 further including notifying the insurer
on behalf of the member when the system communicates that an insurance
payment differs from calculated insurance payment obligation.
4. The system of claim 1 further comprising inquiring to the health
insurer regarding an actual insurance payment different from the
calculated insurance payment obligation.
5. The system of claim 4 further comprising serving as an ombudsman
between the member and the health insurer.
6. The system of claim 4 wherein the ombudsman inquires of the
health care provider or employer.
7. The system of claim 6 wherein the ombudsman collects information
from the health care provider, insurer, member, or employer.
8. The system of claim 7 wherein the ombudsman transmits information
to the insurer.
9. The system of claim 5 further comprising the ombudsman mediating
an actual insurance payment different from the calculated insurance
10. The system of claim 5 further comprising storing information
on at least one server.
11. A health benefit ombudsman service comprising the steps of
a) receiving health insurance contract information, b) receiving
an inquiry from an insured regarding the health insurance contract,
c) collecting information from a database of health provider information
or health insurance contract information; and d) communicating information
and the inquiry to the insurer.
12. The ombudsman service of claim 11 further comprising requesting
information from the insurer.
13. The ombudsman service of claim 11 further comprising requesting
information from a health care provider.
14. The ombudsman service of claim 11 wherein the service is provided
to a paid member of a health insurance monitoring service.
15. A medical insurer payment monitoring and resolution system
comprising: a) establishing representation authority b) entering
an policy payment obligations; c) entering medical expense event
information; d) calculating an insurer payment obligation for the
medical expense event; e) entering an actual insurer payment for
the medical expense event; f) evaluating the actual insurer payment
with the insurance payment obligation; g) marking a payment evaluation
for inquiry if actual insurance payment is less than the insurance
payment obligation; h) communicating to the insurer a marked evaluation
of actual insurance payment with event payment obligation; and i)
initiating resolution of marked evaluation.
16. The system of claim 15 wherein resolution comprises mediation.
17. An member subscription health insurance payment data collection
and evaluation apparatus comprising: a) at least one computer server
having an interface for communication over a computer network and
further comprising at least one CPU with data input and display
capability; b) an application program collecting and displaying
member information, health insurance contract information, medical
event information, evaluating medical event information and health
insurance contract information, issuing alerts of payment non compliance;
and c) a memory component for storing data for access by an application
program being executed on a CPU comprising a data structure including
member name, member health insurance contract, member medical event,
evaluation of health insurance contract to medical event and evaluation
18. The apparatus of claim 17 further comprising a login and password
control center for controlling assess to members and system associates.
19. The apparatus of claim 17 further comprising a mechanism for
membership or subscription payment.
20. The apparatus of claim 17 further comprising a component for
 This application claims priority to provisional application
60/682,694 entitled "System for Tracking Insurance Milestones
and Payments with Policy and Plan Provisions" and filed May
BACKGROUND OF INVENTION
 1. Technical Field
 The invention pertains to administrating, monitoring and
management of member health care expenses, and the ability to administrate
health/medical saving account payment/reimbursement involving medical
expenses and insurance.
 2. Related Art
 Insurance companies, employers, or a third party administrator
provide telephone banks accessible to its insured providing listings
of filed claims and the status of payments.
SUMMARY OF INVENTION
 A system that stores and tracks all member healthcare expenses,
using private and secure Internet accounts to monitor payments of
their Managed Care (HMO/PPO) provider or insurer. A system that
has the ability to track and administrate Health/Medical Saving
Accounts and also tell a member based on the total amount of any
expense what they should expect the insurer to pay and what they
(member/insured) should expect to pay towards that expense. The
invention utilizes expense tracking computer software that automatically
alerts members when the insurer has failed to pay the full amount
of medical expenses as required under the medical insurance policy.
The customer service component of the invention allows the initiation
of contact with that member's Managed Care (HMO/PPO) or insurer
to discuss the issue of payment on behalf of that member. The system
also includes an ombudsman to administer inquiries between members
and insurers with benefit management online their HMO/PPO, healthcare
provider or employer to work towards positive resolution on expense,
coverage or problem/issues and question for members offering supplemental
or itemized bill review and pre-paid legal assistance when a system
administer can't resolve a member issues or healthcare needs.
 The invention pertains to monitoring insurance payment of
medical event expenses for compliance with the terms of the insurance
policy. The invention can include a system for entering insurance
payment obligations, entering medical expense event information,
calculating dollar value of insurance payment obligation for expense
event, entering dollar value of actual insurance payment, evaluating
actual insurance payment with event payment obligation, and marking
expense event for inquiry if event payment obligation exceeds actual
SUMMARY OF DRAWINGS
 Diagram 1 contains a high level outline of the functions
of the invention, including user account management.
 Diagram 2 illustrates an embodiment of the steps that may
be taken to establish a user membership or for a member user to
log into the invention.
 Diagram 3 iMed Internet Architecture.
 Diagram 4 illustrates a member user accessing the account
summary page of the invention. Illustrated are the options presented
to the user including adding or editing member milestones, adding
or editing members and personal data, etc.
 Diagram 4C illustrates steps that can be taken through the
"add/edit member milestone" option including modification
of insurance policy terms and information.
 Diagram 4E illustrates the centralized function of the account
management function of the invention. Included is the transition
from the account summary page to account page and then to functions
such as event (payment) management and inquiry management.
 Diagram 5 illustrates the steps of creating an event wherein
medical expenses are incurred and the user's insurance policy participation
is monitored for compliance with policy payment obligations. This
process commences from the account page.
 Diagram 6A illustrates event tracking and alert system.
The medical expense is evaluated with the medical insurance payment
obligations. Comparison is made of actual payment and calculated
or expected payment.
 Diagram 6B illustrates optional embodiment wherein system
makes inquiry on user behalf to resolve discrepant payment contribution
for medical event.
 Diagram 7A illustrates steps of an embodiment in which user
makes inquiry to the system of the invention. Time devoted or expended
in this inquiry function is assessed against a paid time allocation.
This process commences from the account page.
 Diagram 7B is a continuation of the steps illustrated in
Diagram 7A. Reporting of resolved inquires is illustrated. Members
are notified of inquiry status vial email.
 Diagram 8 iMED Patient Selection
 Diagram 9A illustrates another embodiment of the invention
wherein members may communicate with system representatives. Again
this process starts from the account page.
 Diagram 9B further illustrates the "live chat"
 Diagrams 9C, 9D and 9E illustrate embodiments of member
user technical support, again commencing from the account page.
 Diagram 10A illustrates the process steps wherein a member
user may access a summary of the insurance policy over the Internet.
 Diagram 10B illustrates an embodiment wherein the member
user may modify policy milestones. This step can be implemented
from the account summary page.
 Diagram 10C illustrates the option wherein the user member
may be provided an electronic copy of the actual medical insurance
 Diagram 11A illustrates an embodiment wherein prescription
drug payment may be tracked. This process again starts from the
 Diagram 11B illustrates an embodiment wherein the member
user may modify prescription drug history and payment.
 Diagrams 12A through 12G illustrate the account functions
that can be performed by the system associate in one embodiment
of the system.
 Diagram 13 illustrates steps for administrative view of
 Diagram 14 illustrates the steps for viewing event details.
 Diagram 15 illustrates the steps for correcting medical
event entry and particularly for an "over charge" event.
 Diagram 16 illustrates steps for system associate to add
a new medical event.
 Diagram 17 illustrates the steps for system associate to
viewing medical events.
 Diagram 18 illustrates the steps viewing prescriptions from
the account page.
 Diagram 19 illustrates the steps to view member inquiries
beginning from the account page.
 Diagram 20 illustrates the steps to edit a member account.
 Diagram 21 illustrates the steps to edit member patient
 Diagram 22 illustrates the steps to add a new member patient.
 Diagram 23 illustrates the steps to delete a patient account.
 Diagram 24 illustrates the steps of sending a password to
 Diagram 25 illustrates the steps of editing account card
information. Credit card information will be utilized for a member
to purchase more customer service minutes.
 Diagram 26 illustrates the steps to edit a member's health
insurance contract milestone information.
 Diagrams 27 through 56 illustrate administrative functions
of one embodiment of an application program of the system
 These accompanying figures, which are incorporated in and
constitute a part of the specification, illustrate embodiments of
the invention. The figures, together with the general description
of the invention given above and the detailed description of the
preferred embodiments given below, serve to explain the principles
of the invention. These figures are provided for illustration and
explanation and do not limit the scope of the invention.
DETAILED DESCRIPTION OF INVENTION
 It is well known that the costs of medical treatment have
increased dramatically in recent years, typically outpacing the
cost increases of other segments of the national economy. The role
of third party payment entities has also changed, typically with
growing complexity and with greater sharing of costs with the beneficiary
or "insured". Third party payment or expense reimbursement
entities include traditional health insurance companies, third party
administrators, and Health Saving Account/Medical Savings Account
(HSA/MSA) manager/administrators. These entities also include managed
care providers such as health maintenance organizations ("HMOs")
and preferred provider organizations ("PPOs"). All third
party payors, health maintenance organizations, and expense reimbursement
entities are referred to within this specification as "health
insurers" or "insurers". Further, health maintenance
organization or group plans, PPO plans, health insurance or medical
insurance plans or policies or however else termed for third party
payment of medical or health expenses (including prescription drug
expenses) are hereinafter termed "insurance contracts".
 These entities frequently have lists of established pre-qualified
or pre-approved health care providers forming a network. The health
care cost reimbursement provided to the insured by these entities
may vary depending upon whether the health care provider is pre-approved
or otherwise within the "network". Costs incurred with
an "out of network" health care provider may not be subject
to reimbursement, e.g., not covered an insurance contract, or may
be subject to reduced reimbursement, i.e., a smaller percentage
of the total cost being paid by the insurer with payment of the
remainder being the responsibility of the insured or a pre-tax or
tax exempt/deferred payment or reimbursement by a HSA/MSA network
administrator. The system subject of this invention may be utilized
by HSA/MSA network providers.
 Conversely, the health care provider may be within the insurer's
network but the specific service may not have been pre-approved.
These factors may be material to whether the expense may be reimbursed
or the amount e.g., percentage, of the cost that will be reimbursed.
 Of course certain treatments or health conditions may not
be subject to reimbursement, e.g., non-covered expenses. One example
is cosmetic surgical procedures are typically not covered by a medical
insurance contract. Additionally, treatment procedures may not be
covered by the insurance contract if deemed by the insurer to be
experimental or not within the scope of customary or accepted medical
 All of the above factors, i.e., increased costs and increased
complexity of insurance contract coverage, create an ever increasing
burden for the individual insured. In other words, it is becoming
increasing burdensome for the insured to know if the insurer is
paying all covered medical or health care costs as obligated under
the applicable insurance contract. It may also not be possible to
know if the insured is getting the full medical treatment benefit
from the insurer. The full scope of covered benefits provided by
the insurance contract may not be easily understood.
 Related to the complexity of the terms of contract coverage,
the administrative and management procedures of the insurer and
the health care provider may also discourage the insured from effectively
monitoring the insurer's compliance with the terms of the insurance
contract. Challenging a payment determination made by the insurer
may not only be time consuming, emotionally frustrating but require
the insured to acquire knowledge of healthcare administration and
terminology and insurance contract or health maintenance administration
or terminology. The invention provides a tool that minimizes these
issues for members.
 The invention subject of this disclosure includes a system
that collects health care related costs incurred by an insured,
and compares or evaluates the payment of these costs ("actual
insurer payments") by an insurer with the obligations, i.e.,
terms, of the applicable insurance contract ("calculated insurer
payment obligations" or "X+pect to pay"). The costs
paid by the member are also tracked. This can include payments made
through Health Savings Accounts. The system includes a system administrator
(hereinafter "associate"). If the system detects that
insurer's payments do not comply with the contract terms, the insured
may be notified. Further, the system may include resources (a "customer
service" component described below) whereby inquiry may be
made within the system by insured or on behalf of the insured to
the insurer to resolve a noted expense error or an event of contract
or policy non-compliance.
 Inquiry to the insurer may include presentation of information
and records. Medical records and receipts may be electronically
scanned and transmitted to the system of the invention. With member
authorization, the information may be transmitted to an insurer
to support a claim for further payment. Where necessary, the associate
may participate in calls among the member and insurer or as an ombudsman
on behalf of member to resolve the issue directly with insurer.
 The system subject of the invention may also include (in
addition to medical expense tracking), tracking of eligible preventive
therapy or wellness benefits, claim processing, billing and remittance,
reporting and analytics and electronic billing and document management.
For example, the system may handle the billing and payment of deductibles
from HSA/MSA accounts. In another example, it may create a database
from which insurer payment and coverage trends may be reported and
analyzed. Utilizing electronic scanning and portability of electronic
documents, members may utilize the system to manage their health
care records, including but not limited to reports, diagnostics,
test results, histories, as well as billing and payment records.
 A member's level of participation with the system subject
of the invention may vary. For example, the tracking of health care
expenses (hereinafter "medical expense event") may be
provided at little or no cost. The benefit of associate inquiry
on behalf of the member insured (hereinafter "member")
may be dependant upon payment of varying levels of membership fees
or similar arrangements. A member may purchase additional customer
service minutes through accessing his/her account summary page as
discussed further herein.
 A "member" is deemed to include all beneficiaries
or plan participants, e.g., family members of the insured. Membership
maybe paid through an annual enrollment fees or paid through monthly
installments. Payment may be through the member's employer or other
membership organization. Payment can be through payroll deduction
or as an allocation from other membership dues. Alternatively, the
membership costs may be paid by the member's employer. In yet another
embodiment, the member's costs may vary with usage and/or be paid
through credit card or through automatic account withdrawals or
bank drafts. In an additional embodiment, the system may be compensated
from a percentage of actual additional recovery.
 An individual insured may participate in the system by individual
subscription or as a member in a larger organization, including
as an employee of a participating or subscribing employer. Group
participation may be through other means such as membership in a
fraternal organization or labor union.
 The invention includes a customer service component that
can respond to member questions. For example, the member may request
a bill review or audit of medical charges. The member may request
deductible payments be paid from an HSA account. This customer service
component may, at the member's request and authorization, also make
inquiry to the insurer on behalf of the member regarding insurance
contract payment of medical expenses. This inquiry may include efforts
to resolve or mediate issues regarding actual insurer payments not
complying or matching the calculated ("x-pect to pay")
insurer payment obligations ("non-compliance"). Resolution
may be correction of inputted data, additional payment by the insurer,
revision or amendment of a service provider invoice, etc. In this
role, the system associated may serve as an ombudsman investigating
disputes, reporting facts and mediating fair settlements. The system
creates and maintains the data base which may facilitate the associates'
role as ombudsman to respond to member questions and initiate inquiries
or mediate resolutions. The role of the ombudsman mitigates the
difficulty of an individual member navigating the health insurance
and health care bureaucracy.
 The amount of customer service time utilized by the member
or expended on behalf of a member may be tracked within the system.
In one embodiment, the member maybe entitled to a "prepaid"
amount of customer service time through a basic membership package.
Additional time may be "purchased" by the member. Obviously
a member alerted to a significant monetary discrepancy between actual
insurer contract payment and the calculated insurer payment obligation
under the contract may wish to purchase additional customer service
time in order to achieve the insurer's compliance with contract
obligations. Alternatively, the member may elect to attempt to achieve
resolution through his/her own efforts.
 In another embodiment, the member may elect a plan package
that entitles the member to unlimited customer service time. An
alternative arrangement may include the system retaining a portion
of any additional payment or reimbursement received by the insured.
 In yet another embodiment, the invention includes the ability
of the member to acquire pre-paid legal services. This legal representation
would be directed to providing advocacy and representation for disputes
with the insured regarding insurance coverage and payments that
can not be resolved through a system associate ombudsman. Payment
of these services could be included in the enrollment or membership
fees paid by the member. Membership would permit relevant information
(event data and insurance payment information, contract terms and
evaluations of payment obligations and discrepant payment history)
being made available to the member's authorized representative;
thereby facilitating a seamless transition in resolution of disputes.
 It will be appreciated that one embodiment of the system
subject of the invention facilitates the centralized collection
of member medical event information, including dates, services,
payments, etc. all in a format that is adaptable to insurance administrators.
The member thus has access to a record system, designed for the
member's benefit, which facilitates the audit and mediation of contractually
obligated benefits and payments. The system provides a tool that
enables the member to more productively deal directly with the insurer.
 The system may also possess continuously updated and detailed
knowledge of insurance practices and polices and terms. Coverage
terms may continue to evolve and be amended. The insurance contract
terms may vary depending upon plan type. The system subject of the
invention may assemble an extensive database of policy terms and
coverage determinations which may be accessed in responding to customer
service requests and member inquires. This data base may also facilitate
the ombudsman function of the system. This aspect of the system
may also permit the analysis and reporting of medical events, treatment,
insurance coverage and payment.
 In the preferred embodiment of the invention, the member
sets a predetermined limit or threshold which triggers the marking
of a medical expense event for customer service inquiry. For example,
a medical expense event may total $1000.00 and the insurer's payment
obligation may be calculated to be $800.00 under the terms of the
policy. For various reasons the insurer may actually pay an amount
less than $800.00, thereby increasing the portion of the total expense
that must be paid by the member. The member may agree that only
non-compliance events of an amount of $50.00 or more will be marked
for customer service inquiry. Therefore, if the insurer only pays
$795.00 in contrast to the calculated the $800.00, the system may
not flag the event for inquiry. However, if the insurer only pays
$705.00, creating a non-compliance amount of $95.00, the event will
be automatically flagged for the member's attention and for possible
inquiry by system associates on behalf of the member. Each member
can pre-select the threshold value for marking or alert. This limit
may also be re-set or modified at any time.
 In one embodiment of the invention, the system permits member
access via the Internet. Internet access can allow member enrollment,
private/secure login accounts for data inputting and editing, and
communication with the administrator or customer service. Communication
may be through "live chat" or "live talk", i.e.,
"voice over IP", or internal email. Members may also communicate
with a system associate or customer service via telephone or by
mail. It is envisioned that as a management and cost control tool,
most communication will be through electronic means, i.e., email,
live electronic chat, or notations/comments accompanying data input
 The utilization of Internet functionality permits on line
storage, data inputting and data retrieval of medical events and
member insurance milestone information. Medical event information
can include the date and purpose of a medical expense event, i.e.,
an event causing the member or family member incurring a medical
expense. Where appropriate, this data can include the classification
of the expense in terms of whether it was incurred with an "in-network"
health care professional, incurred as a pre-approved procedure or
treatment, or conversely whether it was incurred through an out
of network health care provider or without pre-authorization or
 Records (receipts, member copies of medical diagnosis, etc.,
from health care providers) may be paperless and stored in PDF,
TIFF or JPEG or similar electronic format. These records may be
stored on memory components of the system accessed by servers.
 Insurance contract milestone information can include tracking
of In-Network/Out-Network expenses chargeable to an insurance deductible,
co-pay, co-insurance or plan year out-of-pocket expense limit. Thus
one component of the invention is the ability to track and summarize
the incurrence of medical expenses, the payment or reimbursement
of these expenses under an insurance contract or HSA (Health Saving
Account) payment/reimbursement and administration, evaluation of
actual payment/reimbursement (hereinafter "actual insurer payment")
and calculated payment obligation under the term of the applicable
insurance policy (hereinafter "calculated insurer payment obligation"
or "x-pect to pay"), and status of yearly deductible and
out-of-pocket expense limitations. The information may be viewed
on a year to date basis or upon a per event basis.
 Data input can be supplied from multiple sources. Basic
payment obligations, such as member co-pay, deductible, out of network
and in-network payments obligations may be obtained or verified
directly from the insurer or the employer/employee. Such data may
include the insurance milestones or allow calculation of such milestones.
In addition, the insurer may supply the medical expense event data,
including the identity of the health care provider, the member or
member's family member receiving treatment, the date of treatment,
the total expense, the amount actually paid by the insurer, etc.
The member may also furnish all or some of this information, or
be able to verify the accuracy of the insurer furnished data and
or payment or furnish reimbursement receipts for repayment from
a pre-tax or tax deferred HSA (Health Saving Account). Utilizing
member furnished information that is prompted by the system to be
correctly and timely inputted may correct insurer information, thereby
enhancing the members' receipt of contractually obligated insurance
 The calculated insurer payment obligation step utilizes
the inputted invoice amount of a medical expense event and calculates
the amount that the insurer is obligated to pay pursuant to the
terms of the contract. This calculation includes the amount of the
policy deductible, the amount of the deductible previously paid
by the member, whether the service provider was In-network/Out-network,
 The invention also includes the web server including computer
network and related components connected to the Internet providing
member access to the content of the system. The inputted data, calculated
insurer payment obligations, customer service inquiries, etc. may
be stored within memory devices including the memory component of
one or more CPUs controlled by one or more servers. The system communicates
with members and insurers by mechanisms including but not limited
to the Internet, including internal or regular email and the World
Wide Web. The system may be accessed by the member and customer
service. The system utilizes account tracking logic built into its
application program that evaluates all inputted events and payments
to insure compliance with insurer payment obligations.
 Thus the invention includes a private/secure database accessible
by members and through customer service. The insurer, in one embodiment,
may be able to input data, such as a new medical expense event or
information of a payment made to a healthcare provider. However
the insurer's access would be limited and may or may not include
communications between customer services and the member or notations
made by either customer service or the member.
 Diagram 1, entitled "iMed Audit High Level Workflow"
illustrates that there may be two differing accounts offered by
the system subject of the invention, i.e., individual/family accounts
101 and corporate accounts 102. If the user, starting from a home
page, is an individual or family member, the user will be directed
to the enter the website 104 and also participate in the account
creation process 105 as discussed more thoroughly in Diagram 2.
As an overview, the system also includes account management process
106, 107 and described in Diagram 4. In one embodiment, the account
management function and service utilizes the application program
tracking logic software for monitoring milestones and payments.
Alternate systems may be used.
 Once the account management step is completed, the member
may receive alerts of payment non compliance 108 as well as later
modify their plan membership, or other relevant information 109.
 Diagram 2, entitled "Account Creation Workflow"
details one embodiment of the startup process of membership in the
service (business method) subject of this invention. Beginning from
the business homepage 120, the user is queried whether he/she is
a member 201. Starting with the non-member 202, the user may select
among various plan levels 204. These options can include level of
prepaid customer support and administrative service that may be
provided. The user may be invited to provide an email address 205.
In the embodiment illustrated, payment is made and accepted, along
with emailed user id 206, 207, 208. At this point, the user may
now link 209 to the member login page 210. A security challenge/procedure
may be implemented 211, 212, 213, 214. The user (now "member")
is directed to new account setup.
 The member provides authorization and consent 216 for the
system to obtain medical and insurance payment information upon
the member's behalf and disclose such information in course of processing
and administering inquiries on the member's behalf.
 The member is directed to the account creation page 217.
One action of this step is the member designating the insurance
plan through which coverage is provided. This will include disclosure
of the standard policy information including but not limited to
insurance company, plan type, co-pays, deductibles, employer, beneficiary,
covered insured, social security numbers, etc, 218. Other personal
information may be collected 219. The inputted information is submitted
to the system and the personal information saved to database 220,
221. The product is an account summary page 222 showing the member's
account based upon the applicable insurance policy.
 It will be understood that an existing member will proceed
directly from the member login 210 entering user id and password
212 and through the security protocol to the account summary page
 In the embodiment described, the member may proceed from
the account summary page to a number of options. These steps 401
are illustrated in Diagrams 4, 4C, 4D and 4E. Generally, the member
may "add/edit member policy milestone information", "add/edit
members and personal data", input "customer service access",
and multiple "account functions via Account Page".
 In addition, the member is able 402 to "view member
messages/alerts", "view customer service minutes"
"view account totals" access "links to stories and
information" and access "links to discounted services."
The member may also purchase additional customer service minutes.
The member may also choose to upgrade his/her membership to allow
 Diagram 4C entitled "iMed-Audit Member Policy Info
Management" illustrates the one embodiment for a member to
update policy information. Beginning with the account summary page,
the member may click a "modify" button associated with
the "add/edit member policy milestone information". This
may allow the member to modify 405 the policy type, policy name,
yearly deductible amount, yearly out-of-pocket, coinsurance, medical
savings account, lifetime maximum, etc. The member may also modify
information such as member name and birth date, etc. In the embodiment
illustrated, the member is queried 406 if more changes are needed.
The member may click "close" 408 and be returned 409 to
the account summary page.
 Diagram 4E, entitled "iMed-Audit Account Management"
illustrates an embodiment of process steps through the system subject
of the invention wherein the process again begins from the account
summary page and particularly from the "account functions via
the account page". The member may enter the event management
system 451, the inquiry management system 452, patient selection
453, prescription management 454, customer service 455 and policy
 Each of these functions and services will be described in
 Diagram 5, entitled "iMed Event Creation and Modification"
illustrates an embodiment of one facet of the invention. Beginning
from the account page link 401 of the account summary, the member
clicks "enter new event" 451. The member is then prompted
to enter information 501 including "type of care", "in
network", "Emergency", "co-pay" "care
date", "ICD-9 Codes", "procedure", "patient
name", "care provider", "event description",
"Bill ID", "Bill amount", "Paid insurance",
"Paid insured", "comments". The information
is submitted 502 to the system. The comments may be coded or indexed
for retrieval or storage for later customer service or ombudsman
fact gathering or mediation. It will be appreciated that data may
be solicited and inputted via an Internet using a field to be populated
with the information. The invention also provides the members the
ability to edit or modify 504 the event information. The member
may click the "+View Details" link 505 and the window
is opened illustrated as FIG. 5-2 551. The member may click "Click
here to Edit changes" 507, displaying 508 the window illustrated
as FIG. 5-3 552. The edited changes may be submitted 509.
 The inputted information may be displayed to the member
in a form similar to FIG. 5-1 550. The invention evaluates the amount
of the medical bill, the nature of services and location (office
visit, emergency room, etc.) and other variables and computes what
portion of the total bill should be paid by the insurer under the
terms of the applicable policy (previously inputted by the member).
The amount of the actual payment by the insurer is also displayed.
A similar evaluation is made by the invention with respect to the
payment made and expected to be made by the member.
 Diagram 6A entitled "iMed-Audit Event Tracking and
Alert System" illustrates an embodiment of the invention wherein
the aspects of the evaluation discussed in the preceding paragraph
are explained in greater detail. From the member furnished data
of the event, the system creates a record 601 of variables including
"care date", "patient name", "event description",
"provider" (i.e., health care provider), "bill ID"
and "bill amount". From this information and the details
of the member insurance plan (previously imputed during "account
creation"), the system evaluates the portion of the event bill
that should be paid ("x+pect to pay") by the insurer 602
and the co-pay obligation of the member 603. The system of the invention
further evaluates 604 the actual payment amount to the calculated
"x+pect to pay" amount and alerts the member to discrepant
payment amounts. In other words, the system of the invention automatically
checks or audits whether the insurer is meeting its contractual
obligations to the member. In the example illustrated, the system
has determined that the insured has under paid the obligation by
 In the embodiment illustrated, the system presents the member
with the information via the Internet in a format similar to the
presentation of FIG. 6A-1 650. The policy data can be summarized
in a format similar to the presentation illustrated in FIG. 6A-2
 In the embodiment illustrated in Diagram 6A, the member
may have selected a threshold level 605 for discrepant benefit payment
performance that will trigger inquiry to the insurer. If the insured
underpayment is below a specified and predetermined threshold, the
system takes no further action 606. If, however, the insured underpayment
is in excess of the threshold, 607, the member is alerted. In the
embodiment illustrated, this alert is communicated by email. Further
the system associate may be alerted 608 to the underpayment for
follow-up inquiry to be made to the insured on behalf of the member.
 Diagram 6B continues the process steps of the illustrated
embodiment of the invention. The member receives the email alert
609 and may navigate to the account page 610 and click his/her name
from the patient selection menu 611. The page is displayed showing
all account activity 612. This may be presented to the member in
a format similar to FIG. 6B-1 652. In the embodiment illustrated,
the discrepant (overcharges) payments are highlighted in yellow
653. The system may also created a correction line 613 highlighting
adjustments achieved by associate inquiry to the insurer. Note that
the occurrence of an inquiry activity may be a function of the membership
level purchased by the member 614, 615. (See step 204 in Diagram
 If the member has purchased the requisite membership level,
the member is prompted 616 to provide consent and authorization
for the system associated to make inquiry on behalf of the member
to the insured concerning the discrepant payment. With the requisite
authorization, the event, services, policy obligations, event charges
and payments made, etc. are reviewed with the insured 617.
 The system associate, possessing knowledge of the event,
insurance policy provisions, service provider practices, dedicated
time to communicate with the insurer, is positioned to productively
make inquiry to the insurer regarding the apparent discrepant payment
and achieve additional payment consistent with policy payment obligations.
It will be further appreciated that the system associate has access
to the relevant records and information inputted by the member in
machine readable format. The information is readily accessible from
electronic databases. It will be further appreciated that the system
associate has access to the member for supplemental information
via email or other electronic communication mechanism. Similarly,
the system associate may have access to the health care provider
(as authorized by the member) in order to obtain additional information
regarding services provided and related documentation necessary
to obtain full payment from the insurer. In this activity, the system
associate may serve as an ombudsman, i.e., investigate complaints,
report findings and mediate fair settlements. (Reference is made
to Diagram 5, step 501 and Diagram 7B step 724 and FIG. 7-3)
 Comments or notations made in the inquiry step 617 may also
be coded or indexed for retrieval or storage for later customer
service or ombudsman fact gathering or mediation.
 The additional insurance payment is recorded 618 and the
revised payment evaluated to the "x+pect to pay" amount
619. The member is notified of the savings achieved by the system
 Diagrams 7A and 7B illustrated embodiments for member inquiry
to the system regarding payment issues, insurance coverage issues
or technical questions concerning accessing member account records.
For example, a member may inquire of MRI coverage under their insurance
contract. A member may also make inquiry regarding payment of a
deductible from their HSA account.
 The process step again commences 701 from the account summary
page with link from the account function via the account page. (See
Diagram 4E) The member selects "patient inquiry" tab.
The member is prompted to "enter new inquiry" window 702
and the system time stamps the inquiry and "time in" 703.
 It will be appreciated that in one embodiment of the invention,
the member has paid for limited minutes of system time in which
inquiries may be made and responses provided. It will be further
appreciated that the member may optionally purchase additional time
or subscribe to a plan with unlimited inquiry time.
 The member enters the question which may be categorized
by type and method. 704 and the inquiry is submitted 705. (See FIG.
7-1 750) The "time out" 706 is mark and elapsed time calculated
707. The new balance of available time is calculated 708. The inquiry
recorded is recorded (defaulted to pending inquiry) and the member
may be returned to the account page 709. The member may also view
the pending inquiry by selecting the "patient inquiry"
tab 713 and viewing the "pending inquiries" 714. The member
may be prompted to a screen illustrated by example to FIG. 7-2 751.
The member may optionally click the "+View" link in the
"view inquiry" column 715 and be presented with the response
screen illustrated by FIG. 7-3 753.
 Diagram 7B illustrates an embodiment for the system associate
to handle a member inquiry. Upon receiving the inquiry the associate
uses the system to view the member's account and look up the inquiry
717. The associate enters the appropriate response to the inquiry
and submits the response 718. The system administrator sends an
email to the member to check their account for a response to the
inquiry 719. The member may check the email and click a link to
login into their account 720. Again, commencing from the account
page, the member may select "resolved inquiries" from
the "patient inquiry" tab 721. The member may be presented
722 with the window or screen "resolved inquiry", an example
of which is displayed as FIG. 7A-1 754. The member may click the
"+view" of the "view inquiry" column 723 and
the member's question and associate's response is displayed 724
as illustrated in FIG. 7A-2 755. The member may close the screen
725 and be returned to the account page 726.
 Diagram 8 illustrates selection of an individual member
from the account page and accessible detail.
 Diagram 9A entitled "iMed Customer Service Management--Live
Chat" illustrates an additional embodiment for customer service
901 again commencing from the account page link of the account summary
page. The inquiry is handled similar to the patient inquiry management
protocol illustrated in Diagrams 7A and 7B discussed above. The
associate receives the data and creates an inquiry 905. Status is
defaulted to pending and the inquiry method set to Live Chat.
 Diagram 9B illustrates the ability of the member to use
Voice of internet protocol to communicate with the system and administrators.
 Diagrams 9C, 9D and 9E illustrate management of member technical
support issues and resolution. Again, the sequence is illustrated
as beginning from the account summary page. The member may open
a technical support window as shown in FIG. 9C-1 951. The member
may select a support category and enter a question or issue 932,
933. The inquiry may be submitted 934 and, in response, the system
customer service system creates a pending support issue. The window
is closed and the member is returned to the account page 935. The
technical support question is handled and status is changed from
pending to resolved. The member may be informed of resolution of
the technical issue by email. In Diagram 9D, the member is provided
the option of monitoring pending technical support inquiries 910.
In Diagram 9E may review the resolved technical support issues 918.
The member may be presented 919 with the resolved technical support
page FIG. 9E-1 954. The member may review 922 the resolved technical
support page 923 presented as FIG. 9E-2 955 containing the issues
and system resolutions. The member may close the page 924 and be
returned to the account page 925.
 Diagram 10A illustrates an embodiment wherein the system
may present the member with a summary of the insurance policy. In
the embodiment illustrated, the member clicks the "coverage
summary" menu tab from the "policy summary" tab 1001.
The member is then displayed the "coverage summary" window
1002 and FIG. 10A-1 1050. The member is queried whether the member
wants to see the coverage summary 1003. If not, the member may be
returned to the account page to execute anther function 1006. If
yes, the member may click the link to the desired record under the
"title" header 1004. In one embodiment the policy summary
is presented to the member via the Internet as a pdf (portable data
format) document 1005. It will be appreciated that this summary
will be the product of the data inputted by the member at signup
or subsequently updated. (See Diagram 10B) In addition, the summary
will include information and policy details from the system's internal
data base of insurance policy coverage and terms. This database
may be continuously updated and supplemented through communications
obtained from corporate or group plan members and directly from
insurers utilizing the member authorizations and consents.
 Diagram 10B illustrates another embodiment through which
a member may update milestone information. See also Diagram 4C.
From the account page, the member clicks the "iMed Modify"
menu on the policy summary tab 1010. The "edit milestone information"
page is displayed 1011 and FIG. 10B-1 1051. The member may make
the desired modifications 1012 and the changed settings submitted
 Diagram 10C illustrates an embodiment wherein the member
is provided through the internet with the actual insurance policy.
In the embodiment, the policy is provided as a pdf (portable data
format) document. The member may access the policy from the account
page by clicking on "actual policy" menu in the "policy
summary" tab 1020. The window depicted in FIG. 10C-1 1052 is
displayed 1021. The member may chose to view the policy 1022 and
the member may click on the link to the desired record under the
"title" header 1023. The policy may be displayed as a
pdf document 1024.
 Diagram 11A entitled "iMed Prescription Creation"
illustrates an embodiment wherein the member may click "new
prescription" from the "new event" tab of the account
page" 1111. The window illustrated in FIG. 11A-1 1150 is then
displayed 1112. The member may enter the desired data and click
"submit" 1113 and a prescription record is then created
as shown in FIG. 11A-2 1151. The member is queried if he/she wants
to view or modify the prescription record 1115. If no, the member
is returned to the account page 1116. If the member wants to view
or modify the prescription record 1117, the steps illustrated in
Diagram 11B are implemented.
 Diagram 11B also illustrates steps beginning from the account
page wherein the member clicks on "prescription drug"
tab 1120. The member is then displayed a list of prescription records
with information 1121 as diagrammed in FIG. 11B-1 1151. The member
is queried whether he/she wants to see the details of the prescription
records. If no, the member is returned to the account page 1124.
If yes, the member may click "+view details" link shown
in the desired event record 1123. A window is opened (as shown in
FIG. 11B-2 1152) displaying the prescription information. The member
may elect to make changes 1126 and the member clicks "edit"
button 1127. Window (depicted as FIG. 11B-3) is opened displaying
the current information along with the data 1128. The member may
modify any data and then click "submit" 1129.
 Diagram 12 A illustrates the password security requirements
1201 of a system associate entering the system
 Diagrams 12A through 56 outline the steps of the application
program comprising one embodiment of the system.
 Diagram 19 illustrates the ability of the system associate
to track and store all inquires. Diagram 20 through 23 illustrates
the ability of the associate to edit a member's account. FIG. 24
illustrates the ability of the associate to transmit a member password
to the member.
 Diagram 25 illustrates the administrative function of maintaining
and updating account payment information 2503. This function allows
the member to acquire additional customer service or ombudsman service
 Diagram 26 illustrates the ability of the application program
to permit modifications 2603 of insurance contract milestones which
may be used in the evaluation of medical events.
 Diagram 37 illustrates an example 3710 of different membership
packages which may be purchased by members. It will be appreciated
that different quantities of customer service minutes may be included
within each package. Members may modify 3706 the membership package.
Reference is also made to Diagrams 38 and 39.
 Diagrams 40 through 51 illustrate the steps that are offered
by one embodiment of the application program for editing the health
insurance contract information including type of contract.
 Diagrams 52 through 54 pertain to the system displays of
 Diagrams 55 and 56 illustrate the history of technical support
and member inquiries.
 While this invention is susceptible of embodiments in many
different forms, there are shown in the drawings and will herein
be described in detail preferred embodiments of the invention with
the understanding that the present disclosure is to be considered
an exemplification of the principles of the invention and is not
intended to limit the broad aspect of the invention to the embodiments
illustrated. The above general description and the following detailed
description are merely illustrative of the subject invention and
additional modes, advantages and particulars of this invention will
be readily suggested to those skilled in the art without departing
from the spirit and scope of the invention.
 While specific embodiments have been illustrated and described,
numerous modifications are possible without departing from the spirit
of the invention, and the scope of protection is only limited by
the scope of the accompanying claims.