Patent ID: 8457982

Claim:
A method for limiting exposure to liabilities in a private medical benefit Plan arising from a need for a specific medical treatment, said method comprising: modifying a criteria of said private medical benefit Plan using a processor to limit payment on behalf of a patient to a provider for said medical specific treatment to a patient for an initial number N of treatments to a predetermined percentage Y % of the private medical benefit Plan's allowable amount for said specific treatment; modifying the criteria of said private medical benefit Plan using a processor to limit payment on behalf of said patient to a provider for providing said patient with said specific treatment in excess of N treatments to an amount which is X % above a Medicare allowable amount for said specific treatment; if said provider accepts assignment of claims from a government sponsored secondary coverage payer, causing said provider to exclusively submit any underpayment of said provider's charges to said government sponsored secondary coverage payer responsible for said patient; and if said provider does not accept assignment of claims, causing said provider to limit any amount billed to said patient to a maximum amount set by a controlling authority.