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Method, apparatus and system for providing insurance coverage and claims payment for single event surgical and diagnostic procedures

  • US 20040267579A1
  • Filed: 06/28/2004
  • Published: 12/30/2004
  • Est. Priority Date: 06/30/2003
  • Status: Abandoned Application
First Claim
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1. A method providing insurance coverage associated with a single surgical event or diagnostic procedure comprising:

  • processing an application for a policy for insurance coverage for said event or procedure;

    assessing a plurality of risk criteria associated with said event or procedure, said criteria comprising one or more of;

    ICD-10CM diagnostic codes;

    CPT procedural codes for surgical and diagnostic procedures;

    ASA and NYHA patient anesthesia risk assessment indexes;

    certification of the center where the surgical or diagnostic procedure is performed;

    national vital statistics on the number and type of surgical and diagnostic procedures performed;

    actuarial tables for life expectancy;

    data for surgical and procedural mortality and morbidity; and

    patient application based on social, demographic, surgical, anesthetic, and patient co morbid factors; and

    current health, life, disability, accident, death, and dismemberment of the insured;

    including utilization of past and new information regarding risks associated with said event or procedure to determining posterior probabilities for said event or procedure;

    determining components of a policy for coverage, said policy having one or more components comprising;

    (1) the extent of coverage, including classifications and types of surgical and diagnostic procedures;

    (2) type of coverage, including death, short term and long term disability, dismemberment, unexpected hospitalization, medical malpractice liability, and other complications inherent of a surgery or diagnostic procedure;

    (3) type of insured, including individuals and employer-association groups;

    (4) type of policy, including stand alone or as a rider on anew or existing policy;

    (5) premiums;

    (6) schedules of benefits; and

    (7) type of offering, if the policy is to be offered to the insured on a voluntary or involuntary basis;

    said components of said policy determined at least in part based upon an assessment of posterior probabilities for said event; and

    determining whether to issue a policy or deny coverage.

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