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At least 181 records · Page 10Linked to original sources
PubMed2005

Perinatal stroke in baby, prothrombotic gene in mom: does this affect maternal health insurance?

BACKGROUND: Maternal prothrombotic disorders may contribute to stroke in the fetus before and during birth. Many of the mothers of children with perinatal stroke have no previous history of pathologic thrombosis. OBJECTIVE: To determine if finding the Factor V Leiden mutation, prothrombin 20210 G-A gene defect, or methylene tetrahydrofolate reductase C677T mutation in an asymptomatic mother of a child with perinatal stroke would affect that mother's ability to obtain health insurance. METHODS: 1) The authors reviewed the literature on genetic prothrombotic risk factors and health insurance. 2) The authors surveyed the 17 largest insurance carriers in Indiana to find if diagnosing genetic prothrombotic risk factors in asymptomatic mothers of children with perinatal stroke would affect the mothers' health insurance status. RESULTS: Three articles on genetic prothrombotic risk factors and insurance were identified. Twelve of 17 insurance companies responded to our survey; three had policies on genetic testing. Most companies refused to provide clear, useful information on their policies regarding these risk factors. CONCLUSIONS: The authors are currently unable to counsel their patients' families on the long-term insurance implications of screening for genetic prothrombotic risk factors. The insurance implications of diagnosing healthy women with genetic prothrombotic risk factors need further study.

Blood Coagulation Disorders↗
PubMed2002

Finance issue brief: insurer liability: year end report-2002.

When a health plan denies payment for a procedure on grounds that it is not medically necessary or when it refuses a physician-ordered referral to a specialist, has it crossed the line from making an insurance judgment to practicing medicine? If the patient suffers harm as a result of the decision, is the plan liable for medical malpractice? Those were questions 35 states considered in 1999, and at least 32 states are grappling with this year as they seek to respond to physician and patient pressure to curb the power of the managed care industry. Traditionally, health insurers have been protected by state laws banning "the corporate practice of medicine," which means the patient's only recourse is to sue under a "vicarious liability" theory. Now, however, lawmakers are debating legislation to extend the scope of malpractice liability beyond individual practitioners to insurance carriers and plans themselves.

Employee Retirement Income Security Act↗
PubMedDate not supplied

How to complete a medical insurance form.

The information submitted is knowledge accumulated over years of experience teaching dentists how to bill medical insurance. This is supplemented with a good number of personal expert witness testimonies in criminal and malpractice insurance cases. The objective is to prevent problems before they start with the prudent use of information. My experience in court testimony on these issues has shown me that there is an army of lawyers, insurance company fraud examiners, and dentists working for the aforementioned, just waiting for you to improperly use this method of insurance reimbursement. Use this only if you understand the nuances of what it is you are doing! For example, any procedure you bill to dental insurance using CDT-2 codes can be billed to medical insurance using medical insurance CPT-95 codes. The difference is that if the procedure is not a covered medical expense, it will not be paid by the medical insurance carrier. I strongly suggest that you do not fall into the trap of obfuscating these codes. There are a number of so-called insurance "gurus" teaching dentists how to write confusing and misleading operative reports so as to obtain reimbursement for procedures that normally would not be covered. I beseech you--please do not do it! The penalties are severe. You will experience a significant increase in payments from the medical insurance when procedures are submitted in the proper manner. More and more computerized dental insurance management programs are offering their clients the ability to automatically cross-code and submit dental/medical insurance claims. It is a recognized ability of dentists to do such. Billing responsibly is of the utmost importance.

Forms and Records Control↗
PubMed1988

Controlling workers' compensation costs.

Providers should try to prevent as many losses as possible through inservices on proper lifting techniques, placing wet-floor signs while mopping, etc. The losses which can't be prevented must be controlled. Implement easy-to-understand, yet effective, policies and procedures, making the injured employees and insurance carrier accountable. Stop relying exclusively on those traditionally relied upon to provide risk management services. Brokers/agents seldom have the technical training in all aspects of insurance or the knowledge of the day-to-day operations of an employer. Insurance companies are more concerned about their costs than how ineffective claims handling and inadvertent over-reserving affects a facility's day-to-day operations and premiums. If an employer is large enough, it should hire someone in-house or subcontract risk management services if the service company proves that it knows how to implement and monitor a cost-effective risk management program. Taking the old adage, "you have to spend money to make money," one step further: "you have to spend a little money to save lots of money."

Cost Control↗
PubMed1995

An investigation of the effects of lifestyle on care-seeking behavior using data from health insurance claims.

To clarify the effects of lifestyle on care-seeking behavior, we conducted a questionnaire survey using Morimoto's 8 lifestyle factors and tabulated the medical evaluations at annual medical checkup of 1212 male white-collar employees of a company (aged 21-60 years in 1991), and then extracted the health insurance data for these subjects for the first half of 1992 from the health insurance-carrier computer system. The percentage of employees who visited medical facilities, the number of days of medical care, and the medical fees reported on the health insurance claims were chosen as indices of care-seeking behavior, and the relationship of each index to lifestyle and medical checkup data was examined. The health practice index (HPI), which was obtained by summing the scores for the 8 lifestyle factors was associated with the medical evaluation as expected, but was inversely correlated with the indices of care-seeking behavior. The percentage of employees who visited medical facilities, the number of the days of medical care, and the total medical fees were all higher for the subjects with high HPI scores than for those with low HPIs. Our findings are consistent with those of other researchers who have found an inverse relationship between tobacco smoking and health insurance claims, which has been attributed to the degree of consciousness of health. Compared to smokers, non-smokers have high consciousness of health and tend to consult a doctor more frequently, with resulting increased frequency of medical facility consultation and days of medical care, as well as medical fees. Lifestyle is an important aspect of physical and mental health status.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Use of maintenance insurance to minimize costs.

Hospitals are under tremendous pressure to compete for growth and survival. Increasing focus on the importance and criticality of cost containment has placed a much greater emphasis on the need to improve the cost effectiveness of healthcare facilities. All Clinical Engineering departments will be faced with intense financial pressures from administrators. In the area of equipment maintenance, besides four traditional approaches, maintenance insurance is a relatively new approach. It can be an effective method to save significant amounts of money for the hospital, depending on how it is administrated, cooperation of the authorized departments, the role of the administrator and choice of insurance carriers.

Biomedical Engineering↗
PubMed1992

Collection from third party payers of reasonable costs of healthcare services--DoD. Final rule.

This final rule would amend the DoD regulation that implements 10 U.S.C. 1095. This statute generally provides for collection by the United States from third party payers of reasonable costs of healthcare services provided in facilities of the Uniformed Services to DoD beneficiaries who are also beneficiaries under the third party payer's plan. This final rule also implements recent legislative amendments that expanded their third party collection authority to cover outpatient services, automobile liability and no-fault insurance policies, and Medicare supplemental insurance plans. Active duty members are included in collections from automobile liability and no-fault insurance carriers. In addition the final rule revises methods for determining reasonable costs for inpatient care services.

Government Agencies↗
PubMedDate not supplied

Multiple chemical sensitivity: treatment and followup with avoidance and control of chemical exposures.

Reducing unnecessary chemical exposures, particularly pesticides and other petrochemicals, shows promise for reducing illness episodes in the chemically sensitive. Because similar types of exposures have been associated with the onset of chemical sensitivity, such precautions could have wider preventive value for the rest of society as well. Many uses of chemicals have dubious social benefits, and reduced use should be achievable. The chemical industry will likely bitterly contest the reduced use of chemicals because it stands to lose substantial sales. Compensation and liability insurance carriers also stand to lose if the environment is found problematic, rather than individual psychology, for example. Professionals should also recognize conflicts of interest for the chemical and insurance industries by openly acknowledging funding sources for research. The author believes that research on chemical sensitivity that blames the psyche of the victim rather than the chemical will more likely be funded by the insurance or chemical industry than will other research. Study designs should be developed in an atmosphere removed from financial conflicts of interest. This means a substantially larger role for government funding of research on chemical sensitivity to avoid biasing the knowledge base by financially interested parties. The time is critical for government funding of research on chemical sensitivity because the illness is being defined and characterized. If preliminary research is flawed by improper design and focus, our understanding of the problem could be delayed for years.

Adult↗
PubMed2003

[Framework for qualified inpatient withdrawal treatment of alcoholics in North Rhine-Westphalia].

The programme against addiction, set up by the Ministry for Women, Family, Youth and Health of North Rhine Westphalia, Germany and with broad participation from all groups concerned (MfjFG 1999), seeks the improvement of qualified in-patient withdrawal-treatment for alcoholics. Under the leadership of a district administration, a congress comprising seven one-day workshops was held for representatives of the Ministry, health insurance funds, pension insurance carriers and physicians. They agreed on the basic concept outlined below. Low-threshold access, diversity of essential treatment goals, financial obligation on the part of the regular health insurances, nursing staff, physicians, social workers, and non-verbal therapists according to the decree for psychiatric hospitals in Germany (Bundesregierung 1990), a regular in-patient-period for uncomplicated detoxification and motivation of up to 21 days, prolonged in justified cases up to six weeks, and the integration in the regional help-system for persons with substance-use related problems are essential features of this concept.

Alcoholism↗
PubMed1989

Dental implants and third party carrier coverage.

In the exciting arena of successful dental implantology, we can only anticipate improvement and overall progress. For the dentists who have the opportunity to participate and share their skills with the public, it is hoped that such services will be uniformly accepted by third-party insurers. Training in implant construction is currently being incorporated into both predoctoral and postdoctoral curricula. According to Worthington, it is estimated that by 1992, 300,000 implants will be used per year in the United States, and that there will be a fall in the average cost of each implant. The problems of financial underwriting are at present complicated and somewhat ambiguous. It is hoped that these problems will be resolved by conferences of national representation of dentistry, medicine, and insurance carriers. At present, however, it is a vital problem, and every practitioner in the field of dental implantology should consider his or her role in urging recognition and reimbursement of a covered service.

Dental Implantation, Endosseous↗
PubMed1994

The correct usage of the new radiation oncology codes. 77395--3-dimensional simulation; 77419--conformal weekly radiation therapy treatment management; 77432--stereotactic treatment management.

In summary, radiation oncology now has three new related codes describing the 3-dimensional simulation and treatment of relatively small tumor volumes. These codes, when properly used and completely documented, are reimbursable at rates higher than the conventional simulation and treatment delivery codes that they replace. The physician should be cautioned however, that the indiscriminate use of these codes without accurate documentation of the medical necessity could result in penalties and/or pay back in the event of an audit. As with all new codes, we may rest assured that the insurance carrier will be looking very carefully at the documentation of these new and expensive procedures.

Computer Simulation↗
PubMed1992

Selection of a professional liability insurance policy.

A review of the professional liability insurance policy of one corporation's physicians stimulated a review of the policies used to protect the physicians and corporation from the financial risk of professional liability. It was clear that little was known about the insurance carrier. This case study chronicles the group's actions to address this problem.

Decision Making, Organizational↗
PubMed2005

Patient satisfaction in a university hospital emergency department in Turkey.

OBJECTIVE: Patient satisfaction, an indicator of the quality of care provided by emergency department (ED) personnel, is a significant issue for EDs. The purpose of this study was to identify factors associated with patient satisfaction and dissatisfaction, and to describe demographic characteristics of those surveyed in a university hospital ED. METHODS: All adult patients who consecutively presented to the ED between 8:00 a.m. and 5:00 p.m. on weekdays were included in the study. Patients were asked to complete a questionnaire prior to discharge. The questionnaire asked about the attitude, politeness, and efficiency of the medical and ancillary staff, the reason for preferring our centre and reasons for dissatisfaction. RESULTS: Two-hundred and forty-five adult patients presenting to our ED were included in this study. Forty-five percent of patients preferred our ED because of the previous perception of higher quality of care, informed by other people previously treated in this ED unit, and 35% because of restrictions by their health insurance carrier. The main causes of patient dissatisfaction were lengthy waiting times (27%). CONCLUSION: As a result, lengthy waiting time was the major reason for patient dissatisfaction, and high quality care together with insurance restrictions were the main reasons for preference of this university hospital ED.

Adolescent↗
PubMed2000

Voluntary long-term care insurance: best practices for increasing employee participation.

This is the second of two Issue Briefs (April and May 2000) on long-term care (LTC) insurance. The previous Issue Brief addressed the problem of increasing sponsorship, while this report addresses the issue of increasing employee participation. Participation rates in group LTC insurance plans tend to be low. A potential watershed event for the development of the employment-based group LTC market is the proposed LTC program for federal employees and retirees (a program that would have to be enacted by Congress). The perception of a successful offering to federal employees could provide an enormous boost to the group LTC insurance market. Employee communication and education are seen as critical to the success of LTC enrollments. The importance of support shown by an employer for a new LTC plan offering cannot be overstated. Unlike 401(k) plan participation trends, LTC participation rates are highest among large companies. Insurers tend to view the 40-60 age range as the primary target for group LTC insurance, and employee salary as the best predictor of LTC insurance enrollment. Higher educational levels also are associated with higher levels of LTC participation. Perceived need for LTC insurance is perhaps the biggest barrier to the purchase of LTC insurance by employees due to competing financial priorities and the fact that LTC issues are generally off the "radar screens" of younger employees. Plans with skilled nursing home and home care benefits experience higher participation rates than plans lacking these benefits. The availability of lower-cost and long duration benefit options can be an important factor in determining participation. Most sponsors have chosen to offer noncontributory (i.e., fully employee-paid) LTC plans. Employer reluctance to make contributions may be caused by HIPAA's prohibition on the inclusion of LTC insurance in cafeteria plans. One of the major advantages of group LTC plans is the availability of guaranteed issue (i.e., issuing coverage without requiring evidence of insurability) for employees, which is not available in the individual LTC market. It is easy for enrollment to be derailed by the presence of any of a number of harmful conditions, such as employer-sponsors who distance themselves from the offer, ineffective communications, or difficult enrollment processes. Achieving consistently strong levels of participation in LTC plans will require employer-sponsors and their insurance carriers to form strong partnerships, with worker participation as their primary stated goal.

Aged↗
PubMed2000

Universal healthcare: a bold proposal.

One problem with the American health-care system today is not that it's too expensive but that it's too wasteful. The amount spent on health-care in the United States is sufficient to take care of the medical needs of every citizen. The reason that it does not is that the money is far too often is misspent. America already is spending 14% of the gross domestic product and yet we have health-care chaos and 44 million uninsured. Another problem is the lack of trust between payors, insurance carriers, regulators, employers, employees, providers, and patients. Although the financing aspect of health-care is tremendously important, it is even more important to design a plan to spend the money wisely, align the incentives of insurers, payors, patients, and providers, and restore trust between parties. Otherwise we shall continue to be in chaos regardless of how much money we spend on health-care. In this article, we outline our proposal for an ideal comprehensive national health-care plan that will guarantee that we spend our health-care dollars wisely. Our plan would cover all Americans, including the 44 million uninsured, and it would do so at less than the cost of the current system. Because insurance companies are not equipped to oversee medical practice, our plan would place the day-to-day management of the health-care system in the hands of physicians and local physician-run, physician-owned "provider groups." The physicians in these provider groups would be charged with two primary responsibilities: 1) clinically, they would be responsible for providing total quality cradle-to-grave health-care for every patient in their group and 2) economically, they would be responsible for the budget and to spend it wisely. Physicians will be compensated fee-for-service plus an incentive for efficiency, patient satisfaction, and outcome in a broad sense. Physicians would enjoy wide latitude in clinical decision-making without being second-guessed by distant third parties. Our plan places the fiscal responsibility on physicians while at the same time establishing a system of checks and balances to ensure that patients are protected and well cared for. Unlike outwardly similar plans, under this proposal the physicians are owners of the provider groups and the incentives between payors, insurers, providers, and patients are better aligned. It will eliminate the debate about giving patients the right to sue health plans and employers. It would empower large legally organized physician groups to negotiate with insurers. Our plan is a model for spending money wisely. We believe it would benefit, and therefore be embraced, by all parties--physicians, other healthcare providers, employers, insurance companies, the government, and above all the American public.

Budgets↗
PubMed1990

Morbidity, disability, and long-term care of the elderly: implications for insurance financing.

A scarcity of empirical information to specify appropriate provisions and base rates for coverage has hindered the development of long-term-care (LTC) insurance. Data from three nationally representative surveys on the prevalence of morbidity and functional limitations among the elderly population suggest that health status among older Americans is highly dynamic, especially at higher disability levels. The bioactuarial data may help insurers define potential markets of purchasers of policies, and identify the numbers of persons with disabilities severe enough to trigger use of benefits. If the accuracy of individual service predictions could be increased further, reserve requirements and overall costs to LTC insurance carriers might be reduced.

Aged↗
PubMed2006

Patient opinion of urologists' reimbursement.

OBJECTIVES: To determine patient assumptions and opinions of the billing and reimbursement process in an urban urologic practice. Healthcare policy and physician reimbursement has been discussed in political and economic forums; however, few studies exist that reflect a patient's perspective of reimbursement issues. METHODS: An anonymous, voluntary 11-question survey was given to 825 patients during a 10-week interval. The instrument measured patient perceptions on the amounts (in percentages) that would, and should, be covered by insurance carriers and collected by their urologist. It also measured the time frames perceived for these events to occur. Our aim was to evaluate their knowledge of office urologic reimbursement. RESULTS: Overall, 532 patients (75%) surveyed believed their insurance would cover 80% to 100% of their bill. A total of 309 patients (49%) thought their urologist would receive 80% to 100% of the bill, and 383 (60%) thought they should receive that level of compensation (P < 0.0001). Respondents with prior surgical contact thought their urologist would (P = 0.004) and should (P = 0.01) be reimbursed at a greater level than those without prior surgical contact. When asked about the time to reimbursement, 340 (73%) thought their doctor would be paid within 6 weeks compared with 453 (95%) who thought their urologist should be paid within that time (P < 0.0001). CONCLUSIONS: The survey responses demonstrated patients' convictions that their urologists should be reimbursed in a timely manner. Additional studies examining both patient and healthcare provider perspectives are needed to better educate both of these groups on the medical billing and reimbursement process.

Patients↗
PubMed1984

Use of sealants: societal and professional factors.

At present, sealant use continues at a low level in private practice by dentists and hygienists, and is moderate in community programs although there is high interest in their use in public health settings. Widespread delegation of sealant application to hygienists has not occurred even though the majority of state dental practice acts allow it, and even though practicing hygienists are highly interested in applying sealants. Use in federally sponsored programs is minimal or nonexistent. Information about sealants and adequate clinical experience in their application appear minimal in dental training institutions, and few opportunities have existed for continuing education. Generally, knowledge about sealants among dentists is low; many hold doubtful opinions. Insurance carriers, including commercial, provider, and governmental programs, appear reluctant to reimburse for sealants without purchaser demand and organized dentistry's blessings. Although society emphasizes patient rights to informed consent, few opportunities exist for the public, including group insurance purchasers and union negotiators, to learn about sealant use in conjunction with appropriate fluoride use. Public educational materials are sparse. Manufacturer marketing efforts at present, aimed at providers alone, are at best minimal, with a few exceptions; those targeting the public are nonexistent. Organized dentistry's Council statements may have contributed to a constriction, to date, in the flow of public information about sealants from industry. Lack of communication, or miscommunication, between practitioners and dental scientists has resulted in much misinformation and confusion about the value of sealants and their use. And, the contemporary status of dental manpower and the economy of dental practice in the private sector appear to have provided an infertile environment for acceptance of sealants as a primary preventive technology. In the public sector, interest in sealants is high but two primary constraints are inadequate manpower and lack of financial resources. Clearly there has been a time-lag in the adoption of new sealant products, and it is apparent that no one factor can explain this lag; rather, many complex factors must be taken into account simultaneously. Extent of need does not appear to have influenced use, to date. Often, social change is slow, and all things considered, the lag observed for sealants may not be totally unreasonable.(ABSTRACT TRUNCATED AT 250 WORDS)

American Dental Association↗