CLARIVO is an analytical software platform for document intelligence and insurance education. It is NOT an emergency medical service, triage system, or diagnostic tool. If you or someone you are caring for is experiencing a medical emergency, please call your local emergency number (such as 911, 112, or 108) or visit the nearest hospital emergency department immediately. Never delay seeking professional medical treatment based on insurance coverage analysis.
1. No Insurer, Broker, or Agency Relationship
CLARIVO Systems Inc. is an independent technology provider. We are not an insurance company, health maintenance organization (HMO), third-party administrator (TPA), insurance broker, licensed insurance agent, or claims adjuster.
- We do not sell insurance policies, collect insurance premiums, or underwrite risks.
- We do not receive commissions, referral fees, or kickbacks from hospitals or insurance companies.
- Any analysis provided by CLARIVO does not constitute an endorsement or condemnation of any specific health insurance provider.
2. No Medical Advice or Doctor-Patient Relationship
All content generated by CLARIVO — including Copilot answers, Pre-Hospitalization action checklists, and clause matchers — is provided for informational and educational orientation purposes only.
- No Doctor-Patient Relationship: Using CLARIVO does not establish a physician-patient or clinician-patient relationship.
- Clinical Decisions: Medical treatment decisions, choice of hospital procedures, prescription choices, surgical recommendations, and duration of hospital stay must be determined solely between you and your licensed treating physician.
- Medical Terminology Matching: When CLARIVO matches a diagnosis name from a hospital estimate to a specific exclusion clause or waiting period table, this reflects purely typographic and semantic document parsing, not clinical diagnostic validation.
3. The Epistemic Integrity Model & Uncertainty
Unlike standard conversational chatbots that generate answers with unverified confidence, CLARIVO strictly tags information according to our 4-level Epistemic Truth Standard:
Directly quoted verbatim from your uploaded document with page numbers and character offsets.
Data provided during onboarding or chat that has not yet been corroborated by an uploaded document.
Mathematical or logical deductions calculated from two or more known policy clauses.
Missing information that cannot be confirmed without additional document uploads.
4. Decision Sandbox & What-If Financial Simulations
CLARIVO’s Decision Explorer allows you to adjust hypothetical variables (e.g. testing room category changes from Single Room to Twin Sharing, or assuming pre-existing condition waiting period waivers).
Hypothetical Sandbox Notice: Running, saving, or exporting a simulation scenario is purely a mathematical projection. Simulations do not mutate your underlying case facts, do not modify your legal insurance contract, and do not represent a commitment from your insurer to honor the simulated values.
5. Insurer Adjudication Discretion & Filing Deadlines
Insurance policies are governed by strict contractual clauses, statutory regulations (such as IRDAI guidelines in India or state insurance department rules in the US), and specific policy definitions.
- Sole Adjudication Authority: Your insurer and their appointed Third-Party Administrator (TPA) hold sole, unconstrained authority to adjudicate, approve, reject, or apply proportionate deductions to your claim.
- Mandatory Notification Timelines: Health insurance policies typically mandate strict notice periods (e.g. within 24 to 48 hours of emergency hospitalization, or 3 to 7 days prior to planned hospitalization). CLARIVO does not notify insurers on your behalf. You are solely responsible for meeting formal filing deadlines.
- Non-Standard & Network Hospital Terms: Cashless settlement eligibility and hospital tariff agreements are subject to direct contracts between your insurer and the hospital network.