From 80916f6c3e3b13287cbed24d609e70efcf97f697 Mon Sep 17 00:00:00 2001 From: ipu Date: Thu, 31 Jul 2025 22:08:02 +0300 Subject: [PATCH] add drug parser; add iha estimation rules --- .gitignore | 3 +- pyproject.toml | 4 + src/api/v1/router.py | 21 +- src/config.py | 1 + src/drug_price_parser.py | 116 ++++++++ src/examples/estimation_example.py | 208 ++++++++++++++ src/examples/test_validation.py | 304 +++++++++++++++++++++ src/services/estimation_service.py | 418 ++++++++++++++++++++++++++++- src/services/session_service.py | 2 +- uv.lock | 209 +++++++++++++++ 10 files changed, 1271 insertions(+), 15 deletions(-) create mode 100644 src/drug_price_parser.py create mode 100644 src/examples/estimation_example.py create mode 100644 src/examples/test_validation.py diff --git a/.gitignore b/.gitignore index 05b4876..8d80916 100644 --- a/.gitignore +++ b/.gitignore @@ -9,4 +9,5 @@ wheels/ # Virtual environments .venv .env -logs/ \ No newline at end of file +logs/ +.docs/ \ No newline at end of file diff --git a/pyproject.toml b/pyproject.toml index f2a8e88..e0c8992 100644 --- a/pyproject.toml +++ b/pyproject.toml @@ -7,8 +7,12 @@ requires-python = ">=3.13" dependencies = [ "fastapi[standard]>=0.116.1", "httpx>=0.28.1", + "pandas>=2.3.1", "pydantic>=2.11.7", "pydantic-settings>=2.0.0", + "beautifulsoup4>=4.12.0", + "lxml>=4.9.0", + "requests>=2.31.0", ] [project.optional-dependencies] diff --git a/src/api/v1/router.py b/src/api/v1/router.py index c27e63f..6ebf0d7 100644 --- a/src/api/v1/router.py +++ b/src/api/v1/router.py @@ -136,11 +136,30 @@ async def estimate(request: models.EstimationRequest): message=result.get("message", "") )) + # Include validation information in the reason field if there are issues + reason = details.get("reason", "") + if "validation" in estimation_result: + validation_data = estimation_result["validation"] + if validation_data.get("issues"): + validation_issues = "; ".join(validation_data["issues"]) + if reason: + reason = f"{reason}; Validation issues: {validation_issues}" + else: + reason = f"Validation issues: {validation_issues}" + + # Add warnings to reason if any + if validation_data.get("warnings"): + validation_warnings = "; ".join(validation_data["warnings"]) + if reason: + reason = f"{reason}; Warnings: {validation_warnings}" + else: + reason = f"Warnings: {validation_warnings}" + return models.EstimationResponse( status=estimation_result.get("status", "accepted"), details=models.EstimationDetails( dtq=details.get("dtq", False), - reason=details.get("reason", ""), + reason=reason, tier=details.get("tier", 4), total_price=details.get("total_price", 0.0) ), diff --git a/src/config.py b/src/config.py index 5b73bd8..ff97c05 100644 --- a/src/config.py +++ b/src/config.py @@ -13,6 +13,7 @@ class Settings(BaseSettings): TALESTORM_API_KEY: str TALESTORM_AGENT_ID: str TALESTORM_ESTIMATION_AGENT_ID: str + VIRGIL_API_BASE_URL: str diff --git a/src/drug_price_parser.py b/src/drug_price_parser.py new file mode 100644 index 0000000..80f3711 --- /dev/null +++ b/src/drug_price_parser.py @@ -0,0 +1,116 @@ +""" +Drug Price Parser for Drugs.com + +This module provides functionality to scrape drug pricing information +from Drugs.com and return it in JSON format. +""" + +import json +import re +import time +from typing import Dict, List, Optional, Any +from urllib.parse import quote_plus + +import requests +from bs4 import BeautifulSoup + + +class DrugPriceParser: + """Parser for extracting drug pricing information from Drugs.com""" + + BASE_URL = "https://www.drugs.com/price-guide" + + def __init__(self): + self.session = requests.Session() + self.session.headers.update({ + 'User-Agent': 'Mozilla/5.0 (X11; Linux x86_64; rv:140.0) Gecko/20100101 Firefox/140.0', + 'Accept': 'text/html,application/xhtml+xml,application/xml;q=0.9,*/*;q=0.8', + 'Accept-Language': 'en-US,en;q=0.5', + 'Accept-Encoding': 'gzip, deflate, br, zstd', + 'Sec-GPC': '1', + 'Connection': 'keep-alive', + 'Cookie': 'ddc-pvc=8; ddcsubscribe=disabled', + 'Upgrade-Insecure-Requests': '1', + 'Sec-Fetch-Dest': 'document', + 'Sec-Fetch-Mode': 'navigate', + 'Sec-Fetch-Site': 'none', + 'Sec-Fetch-User': '?1', + 'Priority': 'u=0, i', + 'TE': 'trailers' + }) + + def get_drug_prices(self, drug_name: str) -> Dict[str, Any]: + """ + Get pricing information for a specific drug. + + Args: + drug_name: Name of the drug (e.g., 'alprazolam') + + Returns: + Dictionary containing pricing information in JSON format + """ + url = f"{self.BASE_URL}/{drug_name.lower()}#prices" + user_agent = 'Mozilla/5.0 (X11; Linux x86_64; rv:140.0) Gecko/20100101 Firefox/140.0' + + self.session.headers.update({'User-Agent': user_agent}) + + response = self.session.get(url, timeout=15) + soup = BeautifulSoup(response.content, 'html.parser') + + prices_data = self._extract_prices(soup, drug_name) + + return { + "drug_name": drug_name, + "url": url, + "prices": prices_data, + "status": "success" + } + + + def _extract_prices(self, soup: BeautifulSoup, drug_name: str) -> Dict[str, Any]: + """Extract pricing information from the parsed HTML""" + + prices_data = { + "formulations": [], + } + div_content = soup.find('div', {'id': 'content'}) + formulations = div_content.find_all('h3') + for formulation in formulations: + if formulation.get('class'): + break + formulation_name = formulation.get_text() + formulation_data = { + "name": formulation_name.rstrip(), + "dosages": [] + } + dosages_table = formulation.find_next('div') + dosages = dosages_table.find_all('details') + for dosage in dosages: + summary = dosage.find('summary') + spans = summary.find_all('span') + dosage_name = spans[0].find('b').get_text() + dosage_price = spans[1].find_next('b').get_text() + formulation_data["dosages"].append({ + "name": dosage_name.rstrip(), + "price": float(dosage_price.rstrip().replace('$', '').replace(',', '')) + }) + prices_data["formulations"].append(formulation_data) + return prices_data + + +def parse_drug_prices(drug_name: str) -> str: + parser = DrugPriceParser() + result = parser.get_drug_prices(drug_name) + return json.dumps(result, indent=2) + + +if __name__ == "__main__": + import sys + + if len(sys.argv) > 1: + drug_name = sys.argv[1] + result = parse_drug_prices(drug_name) + print(result) + else: + print("Usage: python drug_price_parser.py ") + print("Example: python drug_price_parser.py alprazolam") \ No newline at end of file diff --git a/src/examples/estimation_example.py b/src/examples/estimation_example.py new file mode 100644 index 0000000..b387ac4 --- /dev/null +++ b/src/examples/estimation_example.py @@ -0,0 +1,208 @@ +import asyncio +import json +from typing import Dict, Any +from services.estimation_service import estimation_service + +async def example_estimation_request(): + """Example of how to use the estimation service""" + + # Sample request data + request_data = { + "applicants": [ + { + "firstName": "John", + "lastName": "Doe", + "dob": "1985-03-15", + "gender": "male", + "weight": 180, + "heightFt": 6, + "heightIn": 1, + "nicotine": False + }, + { + "firstName": "Jane", + "lastName": "Doe", + "dob": "1988-07-22", + "gender": "female", + "weight": 140, + "heightFt": 5, + "heightIn": 6, + "nicotine": False + }, + { + "firstName": "Emma", + "lastName": "Doe", + "dob": "2015-11-08", + "gender": "female", + "weight": 65, + "heightFt": 4, + "heightIn": 2, + "nicotine": False + } + ], + "plans": [ + { + "id": "plan_001", + "coverage": "family" + }, + { + "id": "plan_002", + "coverage": "family" + } + ], + "phq": { + "medications": [ + { + "name": "Lisinopril", + "dosage": "10mg", + "frequency": "daily" + }, + { + "name": "Metformin", + "dosage": "500mg", + "frequency": "twice daily" + }, + { + "name": "Albuterol", + "dosage": "90mcg", + "frequency": "as needed" + } + ], + "issues": [ + { + "key": "diabetes", + "details": [ + { + "description": "Type 2 diabetes diagnosed in 2020" + }, + { + "description": "Well controlled with medication" + } + ] + }, + { + "key": "hypertension", + "details": [ + { + "description": "High blood pressure managed with Lisinopril" + } + ] + }, + { + "key": "asthma", + "details": [ + { + "description": "Mild asthma, uses inhaler as needed" + } + ] + } + ], + "conditions": [ + { + "description": "Type 2 diabetes mellitus" + }, + { + "description": "Essential hypertension" + }, + { + "description": "Mild persistent asthma" + } + ] + }, + "income": 75000, + "address": { + "address1": "123 Main Street", + "address2": "Apt 4B", + "city": "Springfield", + "state": "IL", + "zipcode": "62701" + } + } + + print("=== Insurance Estimation Service Example ===\n") + print("Request Data:") + print(json.dumps(request_data, indent=2)) + print("\n" + "="*50 + "\n") + + try: + # Call the estimation service + print("Calling estimation service...") + result = await estimation_service.estimate_insurance(request_data) + + print("Estimation Result:") + print(json.dumps(result, indent=2)) + + # Display a summary + if result.get("status") == "accepted": + details = result.get("details", {}) + print(f"\n=== SUMMARY ===") + print(f"Status: {result['status']}") + print(f"DTQ: {details.get('dtq', False)}") + print(f"Reason: {details.get('reason', 'N/A')}") + print(f"Tier: {details.get('tier', 'N/A')}") + print(f"Total Price: ${details.get('total_price', 0):,.2f}") + + results = result.get("results", []) + if results: + print(f"\nApplicant Results:") + for applicant_result in results: + print(f"- {applicant_result.get('name', 'N/A')} ({applicant_result.get('applicant_type', 'N/A')})") + print(f" Age: {applicant_result.get('age', 'N/A')}") + print(f" BMI: {applicant_result.get('bmi', 'N/A')}") + print(f" Tier: {applicant_result.get('tier', 'N/A')}") + print(f" RX Spend: ${applicant_result.get('rx_spend', 0):,.2f}") + print(f" Message: {applicant_result.get('message', 'N/A')}") + else: + print(f"\nEstimation failed: {result.get('status', 'unknown')}") + if result.get("details"): + print(f"Reason: {result['details'].get('reason', 'N/A')}") + + except Exception as e: + print(f"Error calling estimation service: {str(e)}") + +async def example_minimal_request(): + """Example with minimal required data""" + + minimal_request = { + "applicants": [ + { + "firstName": "Alice", + "lastName": "Smith", + "dob": "1990-01-01", + "gender": "female", + "weight": 150, + "heightFt": 5, + "heightIn": 7, + "nicotine": False + } + ], + "plans": [ + { + "id": "basic_plan", + "coverage": "individual" + } + ], + "income": 50000, + "address": { + "city": "Chicago", + "state": "IL" + } + } + + print("\n=== Minimal Request Example ===\n") + print("Minimal Request Data:") + print(json.dumps(minimal_request, indent=2)) + print("\n" + "="*50 + "\n") + + try: + result = await estimation_service.estimate_insurance(minimal_request) + print("Minimal Request Result:") + print(json.dumps(result, indent=2)) + + except Exception as e: + print(f"Error with minimal request: {str(e)}") + +if __name__ == "__main__": + # Run the examples + asyncio.run(example_estimation_request()) + asyncio.run(example_minimal_request()) \ No newline at end of file diff --git a/src/examples/test_validation.py b/src/examples/test_validation.py new file mode 100644 index 0000000..31b98cd --- /dev/null +++ b/src/examples/test_validation.py @@ -0,0 +1,304 @@ +#!/usr/bin/env python3 +""" +Test script for IHA underwriting validation functionality +""" + +import asyncio +import sys +import os + +# Add the src directory to the path +sys.path.insert(0, os.path.join(os.path.dirname(__file__), '..')) + +from services.estimation_service import estimation_service + +async def test_validation(): + """Test various validation scenarios""" + + print("Testing IHA Underwriting Validation\n") + + # Test Case 1: Valid application + print("=== Test Case 1: Valid Application ===") + valid_request = { + "applicants": [ + { + "firstName": "John", + "lastName": "Doe", + "dob": "15/03/1985", + "gender": "Male", + "weight": 180, + "heightFt": 6, + "heightIn": 0, + "nicotine": False + } + ], + "plans": [{"id": "1", "coverage": 1, "tier": "standard"}], + "phq": { + "medications": [ + { + "name": "Lisinopril", + "dosage": "10mg", + "frequency": "daily" + } + ], + "conditions": [], + "issues": [] + }, + "income": 50000, + "address": { + "address1": "123 Main St", + "city": "Anytown", + "state": "CA", + "zipcode": "12345" + } + } + + result1 = estimation_service._validate_application(valid_request) + print(f"Eligible: {result1['is_eligible']}") + print(f"Issues: {result1['issues']}") + print(f"Warnings: {result1['warnings']}") + print() + + # Test Case 2: Uninsurable medication + print("=== Test Case 2: Uninsurable Medication ===") + uninsurable_med_request = { + "applicants": [ + { + "firstName": "Jane", + "lastName": "Smith", + "dob": "20/07/1970", + "gender": "Female", + "weight": 150, + "heightFt": 5, + "heightIn": 6, + "nicotine": False + } + ], + "plans": [{"id": "1", "coverage": 1, "tier": "standard"}], + "phq": { + "medications": [ + { + "name": "Warfarin", + "dosage": "5mg", + "frequency": "daily" + } + ], + "conditions": [], + "issues": [] + }, + "income": 60000, + "address": { + "address1": "456 Oak Ave", + "city": "Somewhere", + "state": "NY", + "zipcode": "67890" + } + } + + result2 = estimation_service._validate_application(uninsurable_med_request) + print(f"Eligible: {result2['is_eligible']}") + print(f"Issues: {result2['issues']}") + print(f"Warnings: {result2['warnings']}") + print() + + # Test Case 3: Uninsurable condition + print("=== Test Case 3: Uninsurable Condition ===") + uninsurable_condition_request = { + "applicants": [ + { + "firstName": "Bob", + "lastName": "Johnson", + "dob": "10/12/1965", + "gender": "Male", + "weight": 200, + "heightFt": 5, + "heightIn": 10, + "nicotine": True + } + ], + "plans": [{"id": "1", "coverage": 1, "tier": "standard"}], + "phq": { + "medications": [], + "conditions": [ + { + "key": "cancer", + "description": "Lung cancer diagnosed 2 years ago" + } + ], + "issues": [] + }, + "income": 40000, + "address": { + "address1": "789 Pine St", + "city": "Elsewhere", + "state": "TX", + "zipcode": "54321" + } + } + + result3 = estimation_service._validate_application(uninsurable_condition_request) + print(f"Eligible: {result3['is_eligible']}") + print(f"Issues: {result3['issues']}") + print(f"Warnings: {result3['warnings']}") + print() + + # Test Case 4: Height/weight issues + print("=== Test Case 4: Height/Weight Issues ===") + weight_issue_request = { + "applicants": [ + { + "firstName": "Alice", + "lastName": "Brown", + "dob": "05/09/1980", + "gender": "Female", + "weight": 300, # Very high weight + "heightFt": 5, + "heightIn": 4, + "nicotine": False + } + ], + "plans": [{"id": "1", "coverage": 1, "tier": "standard"}], + "phq": { + "medications": [], + "conditions": [], + "issues": [] + }, + "income": 70000, + "address": { + "address1": "321 Elm St", + "city": "Nowhere", + "state": "FL", + "zipcode": "98765" + } + } + + result4 = estimation_service._validate_application(weight_issue_request) + print(f"Eligible: {result4['is_eligible']}") + print(f"Issues: {result4['issues']}") + print(f"Warnings: {result4['warnings']}") + print() + + # Test Case 5: Diabetes risk factors + print("=== Test Case 5: Diabetes Risk Factors ===") + diabetes_risk_request = { + "applicants": [ + { + "firstName": "Charlie", + "lastName": "Wilson", + "dob": "15/01/1975", + "gender": "Male", + "weight": 220, + "heightFt": 6, + "heightIn": 2, + "nicotine": False + } + ], + "plans": [{"id": "1", "coverage": 1, "tier": "standard"}], + "phq": { + "medications": [ + { + "name": "Insulin", + "dosage": "60 units", + "frequency": "daily" + }, + { + "name": "Metformin", + "dosage": "1000mg", + "frequency": "twice daily" + }, + { + "name": "Glipizide", + "dosage": "10mg", + "frequency": "daily" + }, + { + "name": "Lisinopril", + "dosage": "20mg", + "frequency": "daily" + }, + { + "name": "Amlodipine", + "dosage": "10mg", + "frequency": "daily" + }, + { + "name": "Hydrochlorothiazide", + "dosage": "25mg", + "frequency": "daily" + } + ], + "conditions": [], + "issues": [] + }, + "income": 55000, + "address": { + "address1": "654 Maple Dr", + "city": "Someplace", + "state": "OH", + "zipcode": "11111" + } + } + + result5 = estimation_service._validate_application(diabetes_risk_request) + print(f"Eligible: {result5['is_eligible']}") + print(f"Issues: {result5['issues']}") + print(f"Warnings: {result5['warnings']}") + print() + + # Test Case 6: Multiple applicants with mixed eligibility + print("=== Test Case 6: Multiple Applicants ===") + multiple_applicants_request = { + "applicants": [ + { + "firstName": "David", + "lastName": "Miller", + "dob": "12/06/1988", + "gender": "Male", + "weight": 175, + "heightFt": 5, + "heightIn": 11, + "nicotine": False + }, + { + "firstName": "Sarah", + "lastName": "Miller", + "dob": "08/11/1990", + "gender": "Female", + "weight": 140, + "heightFt": 5, + "heightIn": 6, + "nicotine": False + } + ], + "plans": [{"id": "1", "coverage": 1, "tier": "standard"}], + "phq": { + "medications": [ + { + "name": "Donepezil", + "dosage": "10mg", + "frequency": "daily" + } + ], + "conditions": [], + "issues": [] + }, + "income": 80000, + "address": { + "address1": "987 Cedar Ln", + "city": "Anywhere", + "state": "WA", + "zipcode": "22222" + } + } + + result6 = estimation_service._validate_application(multiple_applicants_request) + print(f"Eligible: {result6['is_eligible']}") + print(f"Issues: {result6['issues']}") + print(f"Warnings: {result6['warnings']}") + print("Applicant validations:") + for app_val in result6['applicant_validations']: + print(f" {app_val['name']}: BMI={app_val['bmi']:.1f}, Category={app_val['premium_category']}, Eligible={app_val['is_eligible']}") + print() + +if __name__ == "__main__": + asyncio.run(test_validation()) \ No newline at end of file diff --git a/src/services/estimation_service.py b/src/services/estimation_service.py index ca825a2..c47b477 100644 --- a/src/services/estimation_service.py +++ b/src/services/estimation_service.py @@ -1,8 +1,9 @@ import httpx import json -from typing import Dict, Any, List, Optional -from ..config import settings -from .session_service import session_service +from typing import Dict, Any, Optional, List, Tuple +from datetime import datetime, timedelta +from src.config import settings +from src.services.session_service import session_service class EstimationService: """Service for handling insurance estimation via TALESTORM API""" @@ -11,6 +12,331 @@ class EstimationService: self.base_url = settings.TALESTORM_API_BASE_URL self.api_key = settings.TALESTORM_API_KEY self.agent_id = settings.TALESTORM_ESTIMATION_AGENT_ID + self.insurance_api_base_url = settings.VIRGIL_API_BASE_URL + + # Initialize uninsurable conditions and medications + self._initialize_underwriting_guidelines() + + def _initialize_underwriting_guidelines(self): + """Initialize uninsurable conditions and medications based on IHA guidelines""" + + # Permanently uninsurable conditions + self.permanently_uninsurable_conditions = { + "organ_transplant", "amputation_disease", "emphysema", "chronic_pulmonary", + "oxygen_use", "nebulizer_use", "parkinsons", "multiple_sclerosis", "als", + "lupus", "myasthenia_gravis", "alzheimers", "dementia", "cognitive_disorders", + "aids", "arc", "hiv" + } + + # Conditions uninsurable if diagnosed/treated in past 5 years + self.recent_uninsurable_conditions = { + "coronary_artery_disease", "heart_failure", "pacemaker", "defibrillator", + "enlarged_heart", "valve_surgery", "stroke", "tia", "carotid_disease", + "peripheral_vascular_disease", "rheumatoid_arthritis", "crippling_arthritis", + "cancer", "kidney_disease", "liver_disease", "hepatitis", "cirrhosis", + "alcoholism", "drug_abuse", "mental_nervous_hospitalization", + "heart_rhythm_disorders", "osteoporosis_fractures" + } + + # Uninsurable medications (partial list) + self.uninsurable_medications = { + # HIV/AIDS medications + "abacavir", "lamivudine", "zidovudine", "tenofovir", "efavirenz", "nevirapine", + "atazanavir", "darunavir", "raltegravir", "dolutegravir", + + # Cancer medications + "abarelix", "chlorambucil", "tamoxifen", "anastrozole", "letrozole", + "exemestane", "fulvestrant", "bicalutamide", "flutamide", "goserelin", + "leuprolide", "triptorelin", "bexarotene", "vorinostat", "romidepsin", + + # Severe arthritis medications + "adalimumab", "methotrexate", "infliximab", "etanercept", "golimumab", + "certolizumab", "ustekinumab", "secukinumab", "ixekizumab", "guselkumab", + "tildrakizumab", "risankizumab", "upadacitinib", "tofacitinib", "baricitinib", + + # Dementia medications + "donepezil", "memantine", "galantamine", "rivastigmine", "tacrine", + + # Schizophrenia/psychosis medications + "aripiprazole", "olanzapine", "risperidone", "quetiapine", "ziprasidone", + "clozapine", "paliperidone", "asenapine", "iloperidone", "lurasidone", + "cariprazine", "brexpiprazole", "lumateperone", + + # Parkinson's disease medications + "carbidopa", "levodopa", "selegiline", "rasagiline", "entacapone", + "tolcapone", "pramipexole", "ropinirole", "rotigotine", "apomorphine", + "amantadine", "trihexyphenidyl", "benztropine", + + # Multiple sclerosis medications + "glatiramer", "interferon_beta", "natalizumab", "fingolimod", "teriflunomide", + "dimethyl_fumarate", "alemtuzumab", "ocrelizumab", "cladribine", "siponimod", + "ozanimod", "ponesimod", + + # Severe cardiovascular disease medications + "amiodarone", "warfarin", "dabigatran", "rivaroxaban", "apixaban", + "edoxaban", "clopidogrel", "ticagrelor", "prasugrel", "dipyridamole", + "cilostazol", "pentoxifylline" + } + + # Height and weight thresholds for premium categories + self.height_weight_chart = { + "5'0": {"preferred": (90, 102), "standard": (103, 218), "high": (219, 260)}, + "5'1": {"preferred": (93, 105), "standard": (106, 221), "high": (222, 264)}, + "5'2": {"preferred": (96, 108), "standard": (109, 224), "high": (225, 268)}, + "5'3": {"preferred": (99, 111), "standard": (112, 227), "high": (228, 272)}, + "5'4": {"preferred": (102, 114), "standard": (115, 230), "high": (231, 276)}, + "5'5": {"preferred": (105, 117), "standard": (118, 233), "high": (234, 280)}, + "5'6": {"preferred": (108, 120), "standard": (121, 236), "high": (237, 284)}, + "5'7": {"preferred": (111, 123), "standard": (124, 239), "high": (240, 288)}, + "5'8": {"preferred": (114, 126), "standard": (127, 242), "high": (243, 292)}, + "5'9": {"preferred": (117, 129), "standard": (130, 245), "high": (246, 296)}, + "5'10": {"preferred": (120, 132), "standard": (133, 248), "high": (249, 300)}, + "5'11": {"preferred": (123, 135), "standard": (136, 251), "high": (252, 304)}, + "6'0": {"preferred": (126, 138), "standard": (139, 254), "high": (255, 308)}, + "6'1": {"preferred": (129, 141), "standard": (142, 257), "high": (258, 312)}, + "6'2": {"preferred": (132, 144), "standard": (145, 260), "high": (261, 316)}, + "6'3": {"preferred": (135, 147), "standard": (148, 263), "high": (264, 320)}, + "6'4": {"preferred": (138, 150), "standard": (151, 266), "high": (267, 324)}, + "6'5": {"preferred": (141, 153), "standard": (154, 269), "high": (270, 328)}, + "6'6": {"preferred": (144, 156), "standard": (157, 272), "high": (273, 332)} + } + + def _check_uninsurable_conditions(self, phq: Dict[str, Any]) -> List[str]: + """Check for uninsurable conditions in PHQ data""" + issues = [] + + if not phq: + return issues + + # Check conditions + for condition in phq.get("conditions", []): + condition_desc = condition.get("description", "").lower() + condition_key = condition.get("key", "").lower() + + # Check for permanently uninsurable conditions + for uninsurable in self.permanently_uninsurable_conditions: + if uninsurable in condition_desc or uninsurable in condition_key: + issues.append(f"Permanently uninsurable condition: {condition.get('description', '')}") + + # Check for recent uninsurable conditions (past 5 years) + for recent in self.recent_uninsurable_conditions: + if recent in condition_desc or recent in condition_key: + issues.append(f"Recent uninsurable condition (past 5 years): {condition.get('description', '')}") + + # Check health issues + for issue in phq.get("issues", []): + issue_key = issue.get("key", "").lower() + issue_desc = " ".join([detail.get("description", "") for detail in issue.get("details", [])]).lower() + + # Check for uninsurable issues + for uninsurable in self.permanently_uninsurable_conditions: + if uninsurable in issue_desc or uninsurable in issue_key: + issues.append(f"Permanently uninsurable health issue: {issue.get('key', '')}") + + for recent in self.recent_uninsurable_conditions: + if recent in issue_desc or recent in issue_key: + issues.append(f"Recent uninsurable health issue (past 5 years): {issue.get('key', '')}") + + return issues + + def _check_uninsurable_medications(self, phq: Dict[str, Any]) -> List[str]: + """Check for uninsurable medications in PHQ data""" + issues = [] + + if not phq: + return issues + + for medication in phq.get("medications", []): + med_name = medication.get("name", "").lower() + + # Check against uninsurable medication list + for uninsurable_med in self.uninsurable_medications: + if uninsurable_med in med_name: + issues.append(f"Uninsurable medication: {medication.get('name', '')}") + break + + return issues + + def _check_diabetes_risk_factors(self, phq: Dict[str, Any]) -> List[str]: + """Check for diabetes-related uninsurability factors""" + issues = [] + + if not phq: + return issues + + # Count diabetes and hypertension medications + diabetes_meds = [] + hypertension_meds = [] + + for medication in phq.get("medications", []): + med_name = medication.get("name", "").lower() + + # Diabetes medications + if any(dm_med in med_name for dm_med in ["insulin", "metformin", "glipizide", "glyburide", "glimepiride", "sitagliptin", "saxagliptin", "linagliptin", "alogliptin", "empagliflozin", "dapagliflozin", "canagliflozin", "dulaglutide", "liraglutide", "semaglutide", "exenatide"]): + diabetes_meds.append(medication.get("name", "")) + + # Hypertension medications + if any(htn_med in med_name for htn_med in ["lisinopril", "enalapril", "ramipril", "quinapril", "benazepril", "fosinopril", "trandolapril", "moexipril", "perindopril", "losartan", "valsartan", "irbesartan", "candesartan", "olmesartan", "telmisartan", "eprosartan", "azilsartan", "amlodipine", "nifedipine", "felodipine", "isradipine", "nicardipine", "nifedipine", "diltiazem", "verapamil", "atenolol", "metoprolol", "propranolol", "carvedilol", "nebivolol", "bisoprolol", "hydrochlorothiazide", "chlorthalidone", "indapamide", "furosemide", "bumetanide", "torsemide", "spironolactone", "eplerenone", "doxazosin", "terazosin", "prazosin", "clonidine", "methyldopa", "hydralazine", "minoxidil"]): + hypertension_meds.append(medication.get("name", "")) + + # Check for diabetes risk factors + if len(diabetes_meds) >= 3: + issues.append(f"High diabetes medication count ({len(diabetes_meds)}): {', '.join(diabetes_meds)}") + + if len(hypertension_meds) >= 3: + issues.append(f"High hypertension medication count ({len(hypertension_meds)}): {', '.join(hypertension_meds)}") + + # Check for insulin use > 50 units/day + for medication in phq.get("medications", []): + if "insulin" in medication.get("name", "").lower(): + dosage = medication.get("dosage", "") + frequency = medication.get("frequency", "") + + # Simple check for high insulin dosage (this would need more sophisticated parsing) + if "50" in dosage or "100" in dosage: + issues.append(f"High insulin dosage detected: {medication.get('name', '')} {dosage} {frequency}") + + return issues + + def _check_height_weight_eligibility(self, applicant: Dict[str, Any]) -> Tuple[str, str]: + """Check height/weight eligibility and determine premium category""" + height_ft = applicant.get("heightFt", 0) + height_in = applicant.get("heightIn", 0) + weight = applicant.get("weight", 0) + + if not all([height_ft, height_in, weight]): + return "unknown", "Missing height or weight information" + + # Format height as "5'6" style + height_key = f"{height_ft}'{height_in}" + + if height_key not in self.height_weight_chart: + return "unknown", f"Height {height_key} not in eligibility chart" + + thresholds = self.height_weight_chart[height_key] + + if weight < thresholds["preferred"][0]: + return "underweight", f"Weight {weight} lbs below minimum for height {height_key}" + elif weight <= thresholds["preferred"][1]: + return "preferred", "Eligible for preferred premium" + elif weight <= thresholds["standard"][1]: + return "standard", "Standard premium category" + elif weight <= thresholds["high"][1]: + return "high", "High premium category due to weight" + else: + return "uninsurable", f"Weight {weight} lbs exceeds maximum for height {height_key}" + + return "unknown", "Unable to determine eligibility" + + def _calculate_bmi(self, applicant: Dict[str, Any]) -> float: + """Calculate BMI for an applicant""" + height_ft = applicant.get("heightFt", 0) + height_in = applicant.get("heightIn", 0) + weight = applicant.get("weight", 0) + + if not all([height_ft, height_in, weight]): + return 0.0 + + # Convert to total inches + total_inches = (height_ft * 12) + height_in + + # Convert to meters + height_m = total_inches * 0.0254 + + # Convert weight to kg + weight_kg = weight * 0.453592 + + # Calculate BMI + if height_m > 0: + return weight_kg / (height_m * height_m) + + return 0.0 + + def _validate_application(self, request_data: Dict[str, Any]) -> Dict[str, Any]: + """Perform comprehensive IHA underwriting validation""" + validation_result = { + "is_eligible": True, + "issues": [], + "warnings": [], + "applicant_validations": [] + } + + applicants = request_data.get("applicants", []) + phq = request_data.get("phq", {}) + + # Check for uninsurable conditions + condition_issues = self._check_uninsurable_conditions(phq) + validation_result["issues"].extend(condition_issues) + + # Check for uninsurable medications + medication_issues = self._check_uninsurable_medications(phq) + validation_result["issues"].extend(medication_issues) + + # Check diabetes risk factors + diabetes_issues = self._check_diabetes_risk_factors(phq) + validation_result["issues"].extend(diabetes_issues) + + # Validate each applicant + for i, applicant in enumerate(applicants): + applicant_validation = { + "applicant_index": i, + "name": f"{applicant.get('firstName', '')} {applicant.get('lastName', '')}", + "is_eligible": True, + "issues": [], + "warnings": [], + "bmi": 0.0, + "premium_category": "unknown" + } + + # Calculate BMI + bmi = self._calculate_bmi(applicant) + applicant_validation["bmi"] = bmi + + # Check height/weight eligibility + premium_category, message = self._check_height_weight_eligibility(applicant) + applicant_validation["premium_category"] = premium_category + + if premium_category == "uninsurable": + applicant_validation["is_eligible"] = False + applicant_validation["issues"].append(f"Height/weight: {message}") + elif premium_category == "underweight": + applicant_validation["warnings"].append(f"Height/weight: {message}") + elif premium_category == "high": + applicant_validation["warnings"].append(f"Height/weight: {message}") + + # Check for nicotine use + if applicant.get("nicotine"): + applicant_validation["warnings"].append("Nicotine use detected - may affect premium") + + # Check age + try: + dob = applicant.get("dob", "") + if dob: + # Parse date of birth (assuming format like "dd/mm/yyyy") + if "/" in dob: + day, month, year = dob.split("/") + birth_date = datetime(int(year), int(month), int(day)) + age = (datetime.now() - birth_date).days // 365 + + if age > 80: + applicant_validation["warnings"].append(f"Advanced age ({age} years) may affect eligibility") + elif age < 18: + applicant_validation["is_eligible"] = False + applicant_validation["issues"].append("Applicant must be 18 or older") + except: + applicant_validation["warnings"].append("Unable to determine age from date of birth") + + validation_result["applicant_validations"].append(applicant_validation) + + # If any applicant is ineligible, mark overall as ineligible + if not applicant_validation["is_eligible"]: + validation_result["is_eligible"] = False + + # If there are any critical issues, mark as ineligible + if validation_result["issues"]: + validation_result["is_eligible"] = False + + return validation_result async def get_client(self) -> httpx.AsyncClient: """Get HTTP client for TALESTORM API""" @@ -26,8 +352,28 @@ class EstimationService: headers=headers ) - def _format_estimation_request(self, request_data: Dict[str, Any]) -> str: - """Format the estimation request as a natural language message for the AI""" + async def get_plan_details(self, plan_id: str) -> Optional[Dict[str, Any]]: + """Fetch plan details from the insurance API""" + try: + async with httpx.AsyncClient() as client: + response = await client.get( + f"{self.insurance_api_base_url}/insurance/plans/{plan_id}", + headers={"accept": "application/json"} + ) + + if response.status_code == 200: + return response.json() + else: + print(f"Failed to fetch plan {plan_id}: {response.status_code} {response.text}") + return None + except Exception as e: + print(f"Error fetching plan {plan_id}: {str(e)}") + return None + + + + async def _format_estimation_request_with_plan_details(self, request_data: Dict[str, Any]) -> str: + """Format the estimation request with fetched plan details""" applicants = request_data.get("applicants", []) plans = request_data.get("plans", []) phq = request_data.get("phq", {}) @@ -48,10 +394,30 @@ class EstimationService: message_parts.append(f" Height: {applicant.get('heightFt', '')}'{applicant.get('heightIn', '')}\"") message_parts.append(f" Nicotine use: {'Yes' if applicant.get('nicotine') else 'No'}") - # Add plan information + # Fetch and add detailed plan information for all plans if plans: - plan = plans[0] - message_parts.append(f"\nPlan: Coverage type {plan.get('coverage', '')}") + message_parts.append("\nPlan Details:") + for i, plan in enumerate(plans): + plan_id = plan.get('id') + if plan_id: + plan_details = await self.get_plan_details(plan_id) + if plan_details: + message_parts.append(f"\nPlan {i+1}:") + message_parts.append(f"- Plan Name: {plan_details.get('name', 'N/A')}") + message_parts.append(f"- Coverage Type: {plan_details.get('coverage_type', 'N/A')}") + message_parts.append(f"- Deductible: ${plan_details.get('deductible', 0):,.2f}") + message_parts.append(f"- Premium: ${plan_details.get('premium', 0):,.2f}") + message_parts.append(f"- Coinsurance: {plan_details.get('coinsurance', 0)}%") + message_parts.append(f"- Copay: ${plan_details.get('copay', 0):,.2f}") + if plan_details.get('benefits'): + message_parts.append("- Benefits:") + for benefit in plan_details['benefits']: + message_parts.append(f" * {benefit.get('name', '')}: {benefit.get('description', '')}") + else: + # Fallback to basic plan info if API call fails + message_parts.append(f"\nPlan {i+1}: Coverage type {plan.get('coverage', '')}") + else: + message_parts.append(f"\nPlan {i+1}: Coverage type {plan.get('coverage', '')}") # Add PHQ information if phq: @@ -123,11 +489,28 @@ class EstimationService: async def estimate_insurance(self, request_data: Dict[str, Any]) -> Dict[str, Any]: """Send estimation request to TALESTORM API and parse response""" try: + # Perform IHA underwriting validation first + validation_result = self._validate_application(request_data) + + # If application is not eligible, return rejection immediately + if not validation_result["is_eligible"]: + return { + "status": "rejected", + "details": { + "dtq": False, + "reason": f"Application not eligible: {'; '.join(validation_result['issues'])}", + "tier": 4, + "total_price": 0.0 + }, + "results": [], + "validation": validation_result + } + # Create or get existing session with estimation agent session_id = await session_service.create_session(agent_id=self.agent_id) - # Format the request as a natural language message - estimation_message = self._format_estimation_request(request_data) + # Format the request as a natural language message with plan details + estimation_message = await self._format_estimation_request_with_plan_details(request_data) # Send request to TALESTORM API async with await self.get_client() as client: @@ -194,6 +577,15 @@ class EstimationService: if field not in result: raise ValueError(f"Missing required result field: {field}") + # Add validation information to the response + parsed_response["validation"] = validation_result + + # If there are warnings, add them to the response + if validation_result["warnings"]: + if "warnings" not in parsed_response: + parsed_response["warnings"] = [] + parsed_response["warnings"].extend(validation_result["warnings"]) + return parsed_response except (json.JSONDecodeError, ValueError) as e: @@ -208,7 +600,8 @@ class EstimationService: 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