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update uninsurable issues

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ipu 2025-09-11 22:05:18 +03:00
parent ac57ded876
commit 808d1f6d26
1 changed files with 14 additions and 3 deletions
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17
src/services/estimation_service_v2.py
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@ -55,7 +55,7 @@ BASE_TIERS = {
} }
HEIGHT_WEIGHT_TABLE = { HEIGHT_WEIGHT_TABLE = {
(4, 2): (54, 60, 125, 151), (4, 2): (54, 60, 125, 150),
(4, 3): (56, 63, 130, 156), (4, 3): (56, 63, 130, 156),
(4, 4): (59, 65, 136, 162), (4, 4): (59, 65, 136, 162),
(4, 5): (60, 68, 141, 169), (4, 5): (60, 68, 141, 169),
@ -286,6 +286,13 @@ UNINSURABLE_MEDICATIONS = [
"zoledronic acid" "zoledronic acid"
] ]
UNINSURABLE_ISSUES = [
"alcohol", "alzheimer_disease", "chronic_pulmonary_disorder", "copd", "hepatitis", "liver_disorder",
"myasthenia_gravis", "organ_transplant", "other_cognitive", "nebulizer", "aids", "als", "amputation",
"cancer", "cirrhosis", "emphysema", "multiple_sclerosis", "nervous_disorder", "osteoarthritis",
"parkinson_disease", "senile_dementia", "systemic_lupus",
]
class EstimationService: class EstimationService:
def __init__(self): def __init__(self):
self.base_url = settings.TALESTORM_API_BASE_URL self.base_url = settings.TALESTORM_API_BASE_URL
@ -333,6 +340,8 @@ class EstimationService:
return True, "Applicant is pregnant" return True, "Applicant is pregnant"
for issue in phq.issues: for issue in phq.issues:
if issue.key in UNINSURABLE_ISSUES:
return True, f"Uninsurable issue: {issue.key}"
if issue.key == "surgery": if issue.key == "surgery":
for detail in issue.details: for detail in issue.details:
if detail.key == "not_performed": if detail.key == "not_performed":
@ -342,7 +351,8 @@ class EstimationService:
if condition.key in uninsurable_conditions: if condition.key in uninsurable_conditions:
return True, f"Applicant have uninsurable condition: {condition.key}" return True, f"Applicant have uninsurable condition: {condition.key}"
# issues would be checked by AI
# issues would be partially checked by AI
return False, "" return False, ""
def calculate_age(self, born): def calculate_age(self, born):
@ -459,7 +469,8 @@ class EstimationService:
plan_coverage = self.get_plan_coverage(plans[0]) plan_coverage = self.get_plan_coverage(plans[0])
rx_spend = 0 rx_spend = 0
for applicant_id, applicant in enumerate(applicants): for applicant in applicants:
applicant_id = applicant.applicant
applicant_review_reasons = [] applicant_review_reasons = []
applicant_dtq_reasons = [] applicant_dtq_reasons = []
applicant_accept_reasons = [] applicant_accept_reasons = []