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    • 6. 发明授权
    • Method of limiting insurer exposure to renal dialysis claims liability
    • 限制保险人暴露于肾透析索赔责任的方法
    • US08457982B1
    • 2013-06-04
    • US12397962
    • 2009-03-04
    • John Brophy
    • John Brophy
    • G06Q10/00G06Q50/00
    • G06Q50/22G06F19/00G06F19/328G06Q10/10G06Q10/1057G06Q40/08
    • Systems and methods are provided to limit exposure of medical Plans to high liabilities for renal dialysis without exposing the insured patient to out-of-pocket liability while still allowing the patient to receive dialysis as they need it. In one embodiment, this goal is achieved by providing an ERISA medical insurance Plan structure that limits Plan responsibility to 125% of the Medicare approved amount for the services provided, and simultaneously supplements coverage of the patient under Medicare Part B. Because Medicare regulations prohibit providers from balance-billing patients subsequent to billing Medicare, the patient cannot be billed for amounts in excess of the Plan limits.
    • 提供系统和方法,以将医疗计划的暴露限制在肾透析的高负债上,而不会使被保险患者暴露于自付负担,同时仍允许患者根据需要接受透析。 在一个实施方案中,该目标通过提供ERISA医疗保险计划结构来实现,该结构将计划责任限于所提供服务的医疗保险批准金额的125%,并同时补充医疗保险B部分下的患者的覆盖范围。因为医疗保险法规禁止提供者 在计费医疗保险后的平衡计费患者中,患者不能为超出计划限额的金额计费。