MANAGING A RISK OF A LIABILITY THAT IS INCURRED IF AN INSURER DENIES COVERAGE FOR TREATING AN INSURED FOR A CONDITION

• US 20150112727A1
• Filed: 10/17/2013
• Published: 04/23/2015
• Est. Priority Date: 10/17/2013
• Status: Abandoned Application

• Current Assignee: Elwha LLC (Intellectual Ventures LLC)
• Original Assignee: Elwha LLC (Intellectual Ventures LLC)
• Inventors: BAYM, Michael H., ECKHOFF, Philip A., HYDE, Roderick A., ISHIKAWA, Muriel Y., JUNG, Edward K.Y., KARE, Jordin T., LEUTHARDT, Eric C., MCKNIGHT, Gary L., PAN, Tony S., TEGREENE, Clarence T., WOOD, Lowell L. Jr., WOOD, Victoria Y.H.
• Application Number:
  US14/056,228
• Publication Number:
  US 20150112727A1
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

An embodiment of a risk-management method includes determining a risk that an insurer will deny coverage for treating an insured for a condition, and calculating, in response to a determined risk, a fee for taking an action if the insurer denies coverage for treating the insured. Such an embodiment may aid in managing a risk of a liability that may be incurred if an insurer under a medical insurance policy denies coverage for treating an insured under the policy. Examples of such liability include money owing to a physician or other provider that treated the insured, interest on the money owing, late fees and other penalties, and a downgrading of the credit of the insured or of a party financially responsible for the insured.

Claims

1. A method, comprising:

with a computing apparatus, automatically determining a risk that an insurer will deny coverage for treating an insured for a condition; and

with the computing apparatus, automatically calculating, in response to a determined risk, a fee for taking an action if the insurer denies coverage for treating the insured.

2. The method of claim 1 wherein determining the risk includes determining the risk before the insured is treated for the condition.

3. The method of claim 1 wherein determining the risk includes determining the risk within a treatment period over which the insured is treated for the condition.

4. The method of claim 1 wherein determining the risk includes determining the risk after the insured is treated for the condition.

5. The method of claim 1 wherein determining the risk includes determining a probability that the insurer will deny coverage for treating the insured for the condition.

19. The method of claim 1 wherein the insured is insured under an insurance policy issued by the insurer.

25. The method of claim 1 wherein the fee includes an insurance premium.

26. The method of claim 1 wherein taking the action includes paying an amount to a beneficiary.

37. The method of claim 1 wherein taking the action includes taking legal action against the insurer for payment of at least part of a cost of treating the insured.

39. The method of claim 1, further comprising:

with the computing apparatus, receiving information about the insurer; and

wherein determining the risk includes determining the risk in response to the information.

48. The method of claim 1, further comprising:

with the computing apparatus, receiving information about a medical treatment;

wherein determining the risk includes determining the risk in response to the information; and

wherein treating the insured includes administering the medical treatment to the insured.

50. The method of claim 1, further comprising:

with the computing apparatus, receiving information about an implant that is part of a medical treatment;

wherein determining the risk includes determining the risk in response to the information; and

wherein treating the insured includes administering the medical treatment to the insured.

51. The method of claim 1, further comprising:

with the computing apparatus, receiving information about an individual administering at least part of a medical treatment;

wherein determining the risk includes determining the risk in response to the information; and

wherein treating the insured includes administering the medical treatment to the insured.

6-18. -18. (canceled)

20-24. -24. (canceled)

27-36. -36. (canceled)

38. (canceled)

40-47. -47. (canceled)

49. (canceled)

52-137. -137. (canceled)

138. An apparatus, comprising:

a determiner module configured to determine automatically a risk that an insurer will deny coverage for treating an insured for a condition; and

a calculator module configured to calculate automatically, in response to a determined risk, a fee for taking an action if the insurer denies coverage for treating the insured.

189. The apparatus of claim 138, further comprising:

a receiving module configured to receive information about a facility administering at least part of a medical treatment;

wherein the determiner module is configured to determine the risk in response to the information; and

wherein treating the insured includes administering the medical treatment to the insured.

190. The apparatus of claim 138, further comprising:

a receiving module configured to receive information about a success rate of a medical treatment;

wherein the determiner module is configured to determine the risk in response to the information; and

wherein treating the insured includes administering the medical treatment to the insured.

195. The apparatus of claim 138, further comprising:

a receiving module configured to receive information about an insurance policy issued by the insurer;

wherein the determiner module is configured to determine the risk in response to the information; and

wherein the insured is insured under the insurance policy.

200. The apparatus of claim 138, further comprising:

a receiving module configured to receive information about a coverage-denial rate for a provider of a medical treatment;

wherein the determiner module is configured to determine the risk in response to the information; and

wherein treating the insured includes the provider administering the medical treatment to the insured.

202. The apparatus of claim 138, further comprising:

an analyzer module configured to analyze at least one step of a proposed treatment relative to at least one item covered by an insurance policy issued by the insurer;

wherein the insured is insured under the insurance policy; and

wherein the determiner module is configured to determine the risk in response to the analyzing.

203. The apparatus of claim 138, further comprising a generator module configured to generate a coverage-denial contract that includes at least one recital that a party is to pay the fee and that another party is to take the action if the insurer denies coverage for treating the insured for the condition.

204. The apparatus of claim 203 wherein the coverage-denial contract includes an insurance policy.

223. The apparatus of claim 203 wherein:

the generator module is configured to generate the coverage-denial contract to include at least one recital of at least one step of a medical treatment not covered under the contract; and

treating the insured includes administering the medical treatment to the insured.

243. The apparatus of claim 138, further comprising:

a generator module configured to generate a coverage-denial contract that includes at least one recital that a party is to pay the fee and that another party is to take the action if the insurer denies coverage for treating the insured; and

a receiver module configured to receive information regarding payment of the fee.

244. The apparatus of claim 138, further comprising a generator module configured to generate:

a coverage-denial contract that includes at least one recital that a party is to pay the fee and that another party is to take the action if the insurer denies coverage for treating the insured; and

an offer to sell the coverage-denial contract.

268. The apparatus of claim 138, further comprising a generator module configured to generate a coverage-denial contract that includes:

at least one recital that a party is to pay the fee and that another party is to take the action if the insurer denies coverage for treating the insured; and

at least one recital that grants the other party'"'"'s successor in interest a right to take legal action against the insurer if the insurer denies coverage for treating the insured.

139-188. -188. (canceled)

191-194. -194. (canceled)

196-199. -199. (canceled)

201. (canceled)

205-222. -222. (canceled)

224-242. -242. (canceled)

245-267. -267. (canceled)

269-274. -274. (canceled)

275. An apparatus, comprising:

means for automatically determining a risk that an insurer will deny coverage for treating an insured for a condition; and

means for automatically calculating, in response to a determined risk, a fee for taking an action if the insurer denies coverage for treating the insured.

296. The apparatus of claim 275 wherein the condition includes a medical condition.

297. The apparatus of claim 275 wherein the condition includes a physical condition.

276-295. -295. (canceled)

298-411. -411. (canceled)

412. A non-transitory computer-readable medium comprising:

stored instructions that, when executed by at least one computing apparatus, cause the at least one computing apparatus

to determine automatically a risk that an insurer will deny coverage for treating an insured for a condition; and

to calculate automatically, in response to a determined risk, a fee for taking an action if the insurer denies coverage for treating the insured.

435. The non-transitory computer-readable medium of claim 412 wherein the condition includes a psychological condition.

413-434. -434. (canceled)

436-548. -548. (canceled)