A system allows a health care provider to arrange payment at the time of service for a patient responsibility portion of a health care claim amount, even though the provider may not know what the patient responsibility portion will be until after adjudication. A health care debit card is associated with an account of the patient. At the time of service, the patient presents the card to the provider. The provider uses the card to authorize the system to hold an estimate of the patient responsibility amount in suspense in the patient's account. After adjudication, when the actual patient responsibility amount is known, a transaction set is sent to the system. The system then automatically transfers the actual patient responsibility amount from the patient's account and into the provider's bank account. Any remainder of the suspended funds is left in the patient's account. A trace number is provided so that the provider can reconcile bank statement deposits with transaction set information.