Method, Apparatus and System for Providing Insurance Coverage and Claims Payment for Single Event Surgical and Diagnostic Procedures
First Claim
1. A method of an insurance provider providing a life insurance policy providing insurance coverage to an insured for risk of death associated with a surgical or diagnostic procedure or medical event utilizing a computer system, comprising:
- determining if said insured has any life insurance component of an existing insurance policy, including existing voluntary and/or involuntary life, health, or accidental death and dismemberment policies;
guaranteeing issuance to said insured of said life insurance policy relative to said surgical or diagnostic procedure or medical event without regard to any additional information based on the criteria that the insured has an existing policy;
utilizing computer readable program code to assess, at said computer system managed by said insurance provider, assessing a plurality of risk criteria associated with said surgical or diagnostic procedure or medical event, said criteria defined by data stored in a memory device associated with said computer system and comprising one or more of;
ICD-10CM diagnostic codes;
CPT procedural codes for surgical or diagnostic procedures or medical events and diagnostic procedures;
ASA and NYHA patient anesthesia risk assessment indexes;
certification of the provider of the surgical or diagnostic procedure or surgical event or diagnostic procedure;
national vital statistics on the number and type of surgical or diagnostic procedures or medical events;
actuarial tables for life expectancy;
certification of a facility at which said surgical or diagnostic procedure or medical event is to take place; and
data for surgical or diagnostic procedure or medical event mortality and morbidity;
determining via said computer system pre-defined policy criteria for said policy based at least partially upon said plurality of risk criteria, said pre-defined policy criteria comprising;
(1) extent of coverage;
(2) exclusions;
(3) premiums;
(4) schedule of benefits; and
(5) policy type, and said criteria including that said insured follow provided instructions for said procedure or event, including any post-procedure or event follow-up examination, obtain pre-approval for said procedure or event, and utilize an approved provider or facility, wherein said life insurance policy comprises a new policy for coverage for losses arising from death resulting from said surgical or diagnostic procedure or medical event if said insured has no existing insurance coverage and wherein said policy comprises a new or existing rider in the event said insured has existing insurance coverage;
generating said policy having said pre-defined policy criteria via said computer system and storing information regarding said policy at said computer system;
presenting said policy which was generated by said computer system;
processing, via said computer system, an application for said policy for insurance coverage from said insured for said surgical or diagnostic procedure or medical event including determining whether to issue a policy or deny coverage by inputting application information regarding said policy into said computer system; and
if a policy is issued and said insured dies, accepting a claim into said computer system upon said policy based upon said act, processing said claim using said computer system, and if said claim is determined to be valid, including compliance with said policy criteria by said insured, using said computer system to issue payment for paying said predetermined fixed claim to said insured without regard to claims by said insured to other sources of compensation, including any existing insurance.
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Accused Products
Abstract
A method and system are provided for determining whether to issue insurance coverage for one or more specific events, such as a specific surgical event or diagnostic procedure. The method and system include consideration of a variety of risk criteria associated with the event or procedure, as well as policy coverage components. Preferably, old and new risk data is utilized to determine posterior possibilities for events associated with the event or procedure. Risk data is utilized to determine whether to issue policies, and to determined policy coverage where policies are to be issued, so as to minimize premiums to the insured and maximize profits to the company.
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Citations
16 Claims
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1. A method of an insurance provider providing a life insurance policy providing insurance coverage to an insured for risk of death associated with a surgical or diagnostic procedure or medical event utilizing a computer system, comprising:
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determining if said insured has any life insurance component of an existing insurance policy, including existing voluntary and/or involuntary life, health, or accidental death and dismemberment policies; guaranteeing issuance to said insured of said life insurance policy relative to said surgical or diagnostic procedure or medical event without regard to any additional information based on the criteria that the insured has an existing policy; utilizing computer readable program code to assess, at said computer system managed by said insurance provider, assessing a plurality of risk criteria associated with said surgical or diagnostic procedure or medical event, said criteria defined by data stored in a memory device associated with said computer system and comprising one or more of;
ICD-10CM diagnostic codes;
CPT procedural codes for surgical or diagnostic procedures or medical events and diagnostic procedures;
ASA and NYHA patient anesthesia risk assessment indexes;
certification of the provider of the surgical or diagnostic procedure or surgical event or diagnostic procedure;
national vital statistics on the number and type of surgical or diagnostic procedures or medical events;
actuarial tables for life expectancy;
certification of a facility at which said surgical or diagnostic procedure or medical event is to take place; and
data for surgical or diagnostic procedure or medical event mortality and morbidity;determining via said computer system pre-defined policy criteria for said policy based at least partially upon said plurality of risk criteria, said pre-defined policy criteria comprising;
(1) extent of coverage;
(2) exclusions;
(3) premiums;
(4) schedule of benefits; and
(5) policy type, and said criteria including that said insured follow provided instructions for said procedure or event, including any post-procedure or event follow-up examination, obtain pre-approval for said procedure or event, and utilize an approved provider or facility, wherein said life insurance policy comprises a new policy for coverage for losses arising from death resulting from said surgical or diagnostic procedure or medical event if said insured has no existing insurance coverage and wherein said policy comprises a new or existing rider in the event said insured has existing insurance coverage;generating said policy having said pre-defined policy criteria via said computer system and storing information regarding said policy at said computer system; presenting said policy which was generated by said computer system; processing, via said computer system, an application for said policy for insurance coverage from said insured for said surgical or diagnostic procedure or medical event including determining whether to issue a policy or deny coverage by inputting application information regarding said policy into said computer system; and if a policy is issued and said insured dies, accepting a claim into said computer system upon said policy based upon said act, processing said claim using said computer system, and if said claim is determined to be valid, including compliance with said policy criteria by said insured, using said computer system to issue payment for paying said predetermined fixed claim to said insured without regard to claims by said insured to other sources of compensation, including any existing insurance. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12)
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13. A method of an insurance provider providing a life insurance policy providing insurance coverage to an insured for risk of death associated with a surgical or diagnostic procedure or medical event utilizing a computer system, comprising:
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utilizing computer readable program code to assess, at said computer system managed by said insurance provider, assessing a plurality of risk criteria associated with said surgical or diagnostic procedure or medical event, said criteria defined by data stored in a memory device associated with said computer system and comprising one or more of;
ICD-10CM diagnostic codes;
CPT procedural codes for surgical or diagnostic procedures or medical events and diagnostic procedures;
ASA and NYHA patient anesthesia risk assessment indexes;
certification of the provider of the surgical or diagnostic procedure or surgical event or diagnostic procedure;
national vital statistics on the number and type of surgical or diagnostic procedures or medical events;
actuarial tables for life expectancy;
certification of a facility at which said surgical or diagnostic procedure or medical event is to take place; and
data for surgical or diagnostic procedure or medical event mortality and morbidity;determining via said computer system pre-defined policy criteria for said policy based at least partially upon said plurality of risk criteria, said pre-defined policy criteria comprising;
(1) extent of coverage;
(2) exclusions;
(3) premiums;
(4) schedule of benefits; and
(5) policy type, and said criteria including that said insured follow provided instructions for said procedure or event, including any post-procedure or event follow-up examination, and utilize an approved provider or facility, wherein said life insurance policy comprises a new policy for coverage for losses arising from death resulting from said surgical or diagnostic procedure or medical event if said insured has no existing insurance coverage and wherein said policy comprises a new or existing rider in the event said insured has existing insurance coverage;guaranteeing issuance to said insured of said life insurance policy relative to said surgical or diagnostic procedure or medical event without regard to any additional information based on the criteria that the insured has an existing policy; determining if said insured has obtained a pre-procedure or event medical clearance and, if so, using said clearance as the sole basis for issuing said policy to said insured, said policy having said pre-defined policy criteria via said computer system and storing information regarding said policy at said computer system; presenting said policy which was generated by said computer system; processing, via said computer system, an application for said policy for insurance coverage from said insured for said surgical or diagnostic procedure or medical event including determining whether to issue a policy or deny coverage by inputting application information regarding said policy into said computer system; and if a policy is issued and said insured dies, accepting a claim into said computer system upon said policy based upon said act, processing said claim using said computer system, and if said claim is determined to be valid, including compliance with said policy criteria by said insured, using said computer system to issue payment for paying said predetermined fixed claim to said insured without regard to claims by said insured to other sources of compensation, including any existing insurance. - View Dependent Claims (14, 15, 16)
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Specification