AmEx, Metavante Undergird Cigna System for Medical Payments

Seeking to take some of the complexity out of medical payments and at the same time increase transaction volume, American Express Co. and processor Metavante Corp. have teamed up with insurance giant Cigna Corp. for a planned 2007 rollout of a system they claim will let patients know how much they owe for a medical visit and give providers faster payments with less paperwork. The system, dubbed HealthePass, will be tested in the first quarter with subsequent roll-out with select employers and health-care providers, says a spokesperson for Cigna's Bloomfield, Conn.-based Cigna HealthCare unit. Cigna, one of the nation's top five medical insurers, covers 9.3 million consumers through its various plans and serves 500,000 doctors, hospitals and other providers. HealthePass' developers say the system addresses a weak spot?exactly how much the patient owes and from which accounts the consumer portion of bill should be paid?in so-called consumer-directed health care, an umbrella term for newer medical-insurance plans that have consumers paying higher deductibles and co-pays as medical inflation continues to outstrip overall inflation. Such accounts, typically funded through payroll deductions, may include tax-advantaged health-savings accounts (HSAs) for general medical co-pays, limited-purpose HSAs for vision and dental bills, health imbursement arrangements (HRAs), and flexible spending accounts (FSAs). “It's complicated,” says John Reynolds, president of Metavante Health Care Payment Solutions. “With all of that complexity, we have developed technology on the back end so employees don't have decide which account to pull from. That's Metavante's role in this.” Simplified, HealthePass would work like this: a HealthePass-eligible employee would get an American Express-branded card, typically at the start of the year, for presentment when seeking treatment. After a swipe of the card through the provider's point-of-sale equipment, the cardholder would get a real-time estimate of her co-pay through a link to business-information provider Thomson Corp.'s Thomson Medstat service. Medstat generates estimates using data from the insurer as well as information generated by its national database and predictive modeling. The bill for the treatment would go via the AmEx network to Metavante, which would automatically determine which patient accounts are be tapped for the co-payment. Besides the tax-advantaged funds mentioned above, the employee could link the so-called multi-purse AmEx card to a major-brand credit or debit card account or even an AmEx line of credit. The provider would be paid in full in one transaction with funds from Cigna and the patient's accounts. A key part of HealthePass is AmEx's “hold-and-settle” system to reserve sufficient funds for the co-payment in a process akin to the system card networks use for cardholders' hotel reservations when they authorize a stay but don't know until checkout exactly how much the charge will be. Reynolds says the AmEx system has an advantage over the bank card networks in that it allows indefinite holds during the claims-adjudication process; Visa and MasterCard typically will not let a transaction be held longer than within three days. While most medical claims are settled within 48 hours, he says, health-care transactions often can take longer, forcing providers to generate multiple bills for a single visit. “I think the unique attribute here is the ability to place a hold on that transaction,” Reynolds says. An AmEx spokesperson was unavailable for comment. Besides reducing confusion about patient co-pays, the Cigna spokesperson believes providers will welcome HealthePass because it won't require them to buy new equipment, an impediment to earlier efforts to streamline the payment process, he notes. “We think it is going to take off in a big way,” the spokesperson says. Meanwhile, Metavante's Reynolds sees HealthePass as not only generating more volume to process, but potentially expanding AmEx's and Metavante's respective customer bases. “American Express and to some extent Metavante are getting distribution for these financial-related products through Cigna,” he says.