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PubMed2000

[Review of claims from the Patient Insurance: spinal anesthesia is not completely without risks].

The Patient Injury Claims Department in Sweden grants compensation to patients who have incurred injury in the national health service system. All claims involving spinal and epidural anaesthesia were studied during the period 1997-1999. Serious neurological complications were behind 29 out of 65 claims. These occurred more frequently after epidural anaesthesia (1:4,000) than after spinal anaesthesia (1:13,000) with the exclusion of obstetric epidural anaesthesia (1:40,000). Epidural haematoma occurred in 1:30,000 after epidural anaesthesia, in 1:200,000 after spinal anaesthesia. One epidural abscess occurred in 60,000 epidural anaesthesias, while five cases of meningitis occurred after spinal anaesthesia (1:40,000).

Analgesia, Epidural↗
PubMed2000

Cost of dental services provided in private general practice for an insured population in New South Wales, Australia.

OBJECTIVE: To determine cost of dental services provided to a cohort of insured population 18 years and over, who used private general dental practice in New South Wales, Australia. BASIC RESEARCH DESIGN: This cohort study used the person-years method and Weibull regression for analysis. Setting Data were derived from claims records submitted for rebates by members of a health insurance fund for services they received in private general dental practice during 1 January 1992-31 December 1995. PARTICIPANTS: 75,501 members from New South Wales. MAIN OUTCOME MEASURES: To determine, by age groups, the cost per item of dental service, cost of services received at a visit and cost of services received per year. RESULTS: The median cost per item of dental service received for all ages was A$36.7; with cost increasing with age until 55-64 year age group where an apparent plateau occurred. The median cost of services received at a visit for all ages was Australian dollars 93.5. Cost of services received at a visit increased with age, reaching a plateau in the middle aged groups. The median cost of providing services for all age groups per year was Australian dollar 183.6. The cost of services per year when compared with the youngest age group (18-24 years) increased by about 20% for each successive age group up to the 45-54 year age group. From 55 years onwards the cost levelled off at approximately 70% more than the youngest age group. CONCLUSION: The cost of providing dental services increased with age to reach a plateau in the middle age groups.

Adolescent↗
PubMedDate not supplied

Long-term care insurance underwriting: understanding eventual claims experience.

Little is known about the accuracy of medical underwriting for long-term care insurance. The lack of data on claims experience continues to be an obstacle in testing the ability of medical underwriting to identify above average financial risks. This study used actual claims data to simulate medical underwriting and to examine the risk, duration, and timing of nursing home use for people with conditions that are uninsurable. The results show that at least one older person in seven who is rejected for long-term care insurance due to underwriting may not represent greater financial risk to insurers than do those who are accepted.

Actuarial Analysis↗
PubMedDate not supplied

"We didn't get the claim," and other payer excuses.

How many times have you heard from a third-party payer, "we don't have the claim"? Is it only the health insurance industry that has problems receiving its mail and electronic transmissions? Rather than spend time beating up on the payers, the author provides constructive and proactive approaches to help identify why claims fall into a black hole and how to avoid pitfalls.

Insurance Carriers↗