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PubMed1998

The insurance refund request: a legal analysis.

When an insurance payment is made erroneously to a healthcare provider and no contract between the insurer and provider addresses the issue of refunding such payments, the law relating to restitution generally applies. Restitution does not apply, however, to three exceptions that the courts have used to refuse claims by insurers for refunds of overpayments: the innocent third-party creditor exception, whereby the healthcare provider cannot be unjustly enriched by the overpayment, cannot have induced the mistaken payment, and cannot have known beforehand that the insurer was not obligated to pay; the material change in position exception, whereby the healthcare provider in good faith accepts an overpayment and so does not pursue other means of payment; and the assumption of the risk exception, which occurs when the insurer pays a claim without having complete information about it.

Financial Management↗
PubMedDate not supplied

NMP22: a sensitive, cost-effective test in patients at risk for bladder cancer.

BACKGROUND: This study was designed to determine the clinical utility of NMP22 as a urinary marker for the early detection of transitional cell carcinoma (TCC) of the bladder in patients with hematuria or other indications for risk of malignancy. Its utility will be measured by sensitivity and specificity estimates as compared to cystoscopy. Since urine cytology is normally collected in this population of patients, it will also be analyzed and compared to cystoscopy. MATERIALS AND METHODS: Each patient submitted a single voided urine which was stabilized with the NMP22 urine collection kit or preserved in the appropriate cytology medium for cytopathologic testing. All patients provided the urine samples before cystoscopic exam. Of the 146 patients, there were 43 patients with microscopic hematuria and 13 with gross hematuria. Other indications for cystoscopy included unexplained or medically refractory voiding. There were 8 patients with biopsy confirmed bladder cancer and 138 patients with benign conditions of the bladder. RESULTS: The median NMP22 value for the bladder cancer malignancies was 27.8 U/mL (95% Confidence interval: 10.5-32.1 U/mL). The median NMP22 value for the benign conditions of the bladder was 3.25 U/mL (95% Confidence interval: 2.5-3.8 U/mL). The urinary NMP22 values from the bladder cancer group was statistically different (p < .000001 Mann-Whitney U test) than the NMP22 values in the benign conditions group. Using a reference value of 10.0 U/mL, the sensitivity of NMP22 was 100% with a specificity of 90%, while cytology had a sensitivity of 25% and a specificity of 100%. Due to its high negative predictive value, using NMP22 alone could have eliminated 124 cystoscopies with total savings ranging from $24,824 to $63,264 depending on the type of insurance carrier. CONCLUSIONS: This study indicates that urinary NMP22 is a useful, cost-effective marker for the early detection of bladder cancer.

Biomarkers, Tumor↗
PubMed1999

Focused care of pediatric patients in the dental office.

No dental text can adequately prepare the practitioner with the necessary expertise to treat all presentations or office complications that may arise in the therapy of children. There are times when consultation with the child's parent and pediatrician may answer necessary treatment-related questions. Most chronic conditions do not prevent needed treatment interventions. Any acute illness or exacerbation of a chronic disease should be cleared by the primary care physician before commencing dental treatment. The mainstay of safe practice requires that the dentist to maintain a basic level of understanding of what constitutes an emergency and that office staff receive basic training and are adequately supplied with emergency equipment. Dentists are cautioned to consult their state board or dental society as well as their insurance carrier as to what constitutes necessary emergency equipment in the office and to what level they are responsible for providing emergency care to their patients. There is a great difference within the dental field just as there is with medical specialties. All practitioners, however, are liable for any acts of consignment, and although the intention is not to dissuade anyone from providing assistance in an emergency, supportive care and an immediate call of 911 to activate the local EMS are important. In addition, maintaining a familiarity with the local hospital and emergency department capabilities as well as travel time and distance is also important. Routine reviews and updates on life-saving interventions and resuscitations are good general practice and will save lives.

Child↗