insurance carriers

..Hospitals plan to escalate their push for higher reimbursement while the iron is hot. Yet Oxford Health Plans President and CEO Charles Berg, left, says big profits don't paint the whole picture...

..This study explored how state managed-care patient protection laws affect health insurers' criteria for medical necessity, using bariatric surgery for weight reduction as a case in point...

..In this article, I examine the various dimensions of underinsurance, and propose a typology incorporating those dimensions...

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..quot;Things are really heating up," says Merrill Matthews Jr., left, director of the Council for Affordable Health Insurance...

..The profitability of the commercial health insurance industry, exceptionally strong over the past five years, will henceforth be linked to the budgetary cycles and political fluctuations of state and federal governments...

..The similar needs of public and private employers and payers provide an opportunity for leadership, accelerating innovation and using value-added services to improve safety, quality, and efficiency of health care for all...

..Unfortunately, unless the drivers of health care cost are tamed, the main benefits that people seek from insurance-stable coverage and financial protection--will erode further...

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..Allen Schaffer, M.D., describes how a national health plan combines IT and human resources, and embraces national evidence-based standards, to influence the individual health status of millions of members...

..The article concludes with some useful sources of information on single-payer, universal health care...

..This study evaluates whether these laws are achieving their goals or causing unintended side effects...

..48 to 4.64 after controlling for differences in time perception. These findings highlight the ethical challenge facing physicians and patients in balancing patient advocacy with honesty in the setting of limited societal resources...

..State Medicaid purchasers in particular have found alternative sources for care management and have sound reasons to question whether industry-leading commercial insurers will be responsive to their needs...

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..The welfare effects of the all-or-none model of monopsony are compared to those implied by the traditional model...

..Regression analysis is used to assess the extent to which factors are associated with disagreements in reported insurance status across sources...

..This Article proposes legal solutions to the plight of the patient-as-consumer and asks what that plight tells us about market solutions to the health-care quandary...

..This finding helps to explain the absence of an effect of the FEHB Program directive on total spending, and is relevant to the policy debate in Congress over federal parity...

..injury to patients, and tremendous waste of financial resources to employers and workers' compensation insurance carriers. Healthcare workers consistently rank among top occupations with disabling back injuries, primarily from ..

..We suggest that it may be economically advantageous to health insurance carriers to compensate physicians who help their patients in the execution of a valid document...

On the basis of the statistics provided by health insurance organisations and pension insurance carriers, the incidence, socio-medical significance and cost to the general economy of chronic obstructive airways diseases in the Federal ..

Physicians who offer firearms counseling may increase their legal liability, depending on the attitudes of their medical malpractice insurance carriers.

..All of these patients had their surgical procedures preauthorized as medically necessary by their insurance carriers. All subjective parameters examined were statistically significantly improved following breast reduction (p &..

..To evaluate the accuracy of household survey estimates of the size and composition of the nonelderly population covered by nongroup health insurance...

..consequent rising malpractice premiums, and the threatened economic insolvency of medical liability insurance carriers as a result of the broader economic downturn. The result is a serious public health dilemma...

..therapy has been demonstrated to be an effective treatment for IC in a supervised setting; however, most insurance carriers do not reimburse for exercise therapy...

..Medical information technology companies like Solucient and insurance carriers such as Blue Cross of California have identified and published a list of hospitals that demonstrate superior ..

..They should be reviewed and approved by risk managers or insurance carriers, and documented in such a manner that one obtains maximal protection from legal discovery...

..allegation of negligence that follows a labor-associated adversity, obstetricians-and their liability insurance carriers-have recalibrated obstetric practice in alignment with the increasingly risk-averse preferences of most ..

..However, most insurance carriers will not reimburse for mammaplasties involving less than 1000 g of total tissue resected...

..Therefore politicians and social insurance carriers should be urged to integrate facilities for traumatized refugees into the general health care system and ..

..The successes of the American Academy of Dermatology Association advocacy efforts with insurance carriers are summarized, with an update on the current status of these issues...

..As such, third-party insurance carriers should consider reimbursement for ABPM in hypertension to decrease pharmaceutical cost and its attendant ..

..Veins >12 mm were excluded in the initial study. Many insurance carriers used >12 mm size as reason to not approve the procedure...

..Another problem is the lack of trust between payors, insurance carriers, regulators, employers, employees, providers, and patients...

..b>Insurance carriers, managed care plans, and third-party payers have defended the use of utilization management as an imperfect-..

To provide financial justification for continuing pharmaceutical research in an environment that has met with increasing resistance from insurance carriers to paying for the care of patients enrolled in research studies.

..As a result, most major malpractice insurance carriers have experienced a deterioration of their loss ratios...

..Direct costs of allergies in general are in part available from health insurance carriers. Between 1998 and 2005 the number of nasal preparations and antiobstructive therapies prescribed rose by 15% ..

..Two attempts to enact a Prevention Act have failed. Therefore, this study analyzes how prevention is currently regulated in Germany...

..In an effort to reduce potential malpractice liability, insurance carriers are recommending that practices employ culturally competent "patient advocate"professionals such ..

..Even where ob-gyns are available, hospitals and insurance carriers are limiting their ability to practice the wide range of procedures for which they were trained...

..Alternative therapies were used extensively by OA patients in Hong Kong. Clinicians, health policy makers, and insurance carriers should be aware of the potential health and economic effects in practice and policy formulation.

..and repeat cesarean should be regarded as reasonable options; women, rather than policymakers, providers, insurance carriers, or hospitals, should determine delivery approach...

..Health insurance carriers should, in future, selectively support evaluated and approved medication-based and non-medication-based ..

..Health insurance carriers provide a comparable quality assurance program...

..Gastroenterologists and their patients will have to work together to convince insurance carriers that this isa valuable and cost-effective technology worthy of appropriate reimbursement.

..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...

..To compare the effectiveness and safety of the combination therapy of rituximab (RTX) and intravenous immunoglobulin (IVIg) to other immunosuppressive regimens in the treatment of ocular cicatricial pemphigoid (OCP)...

..The authors assessed opportunities for increasing the rate of effective depression treatment by investigating the market for such treatment in the Pittsburgh area...

..coverage for treatment of significant complications, which might not be reimbursed by patients' health insurance carriers. Complication rates of cosmetic breast operations were reviewed from 13,475 consecutive patients between ..

..Despite the proven positive effect for patients participating in such self-help groups, their financial support with public funds or social insurance carriers is not forthcoming.

..Financial constraints imposed by the government and insurance carriers have accelerated the need for efficiency and excellence in communication, coordination of care, and ..

..the United States is an important issue for patients, physicians, federal and state government agencies, and insurance carriers. Physicians can actively address this healthcare barrier by becoming familiar with established state and ..

..Prior to 1992, insurance carriers could sell any benefits they chose, so long as minimum benefit requirements were met...

..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...

..code only services delivered and not diagnoses, and it is difficult to obtain and merge claims from multiple insurance carriers. In a national demonstration project on the impact of community-based dental education programs on the care ..

..To identify short-term drug abuse treatment location risk factors for ten large, self-insured firms starting January 1, 1989 and ending December 31, 1991...

..Findings suggest that the common weight loss regimen requirements of US insurance carriers were ineffective in producing presurgical weight loss in this sample...

..and influences affecting professional behavior, with many specifically citing pharmaceutical companies and insurance carriers (46.3%); (2) the role and importance of physician advocacy on behalf of their patients (37...

..systems; and (c) lack in evidence of actual positive changes effected by the new players: mandatory health insurance carriers and funds...

..For smokers using long-term cessation medications, health care providers should encourage treatment and insurance carriers should cover it...

..Patient demographics, comorbidities, insurance carriers, and indications for operative intervention were analyzed...

..001). Only 38.7% stated that they were educated as to what problems are considered emergencies by their insurance carriers. PED referrals for nonurgent complaints are required by the insurance carrier for 74...

To ensure that insurance carriers pay providers in a timely manner, Texas has adopted strict payment regulations. Enforcement of the regulations has led to restitution payments for many providers...

..mental disorders of more than 6 months' duration may be classified by the medical services of the health insurance carriers as being in need of rehabilitation...

..We found little evidence that the policy change affected premiums charged by insurance carriers in Missouri, but conclude that other desirable aspects of the change make it potentially attractive for ..

..Plan for lower Medicare payments by negotiating with commercial insurance carriers for contract renewals and implementing cost containment measures...

..infertility have extremely variable protocols, success rates, patient access, and costs to both patients and insurance carriers. For most infertility treatments, success rates are lower than natural rates in fertile couples, and for ..

..The health insurance carriers included in the study cover over 75% of the commercially insured lives in the state and sell products that ..

Between 1995 and 1997, 32 states passed laws requiring insurance carriers to provide minimum postpartum length of stays and a similar federal law went into effect on January 1, 1998...

..will likely involve partnership with a company already active in our target markets such as disease management companies, large insurance carriers, or pharmaceutical companies that make anti-depressant medication.

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..An administrative core will support the entire project. A data and methods core provides data and computing support, and serves as a focus for intellectual activity around measurement and statistical issues. ..

..In planning quality improvement activities, it is vitally important for states and providers to understand whether initiation, engagement and continuity of treatment are linked to key outcomes. ..

..If an association is not found, this would provide reassurance to continue prescribing certain antidepressant medications to women diagnosed with breast cancer. ..

..Our proposed endeavor will generate new knowledge for wide dissemination and publication that can inform future evidence-based PGR ethics guidelines and generate further empirical ethics research on PGR. ..

..Our proposed endeavor will generate new knowledge for wide dissemination and publication that can inform future evidence-based PGR ethics guidelines and generate further empirical ethics research on PGR. ..

..We will provide an example of how such estimates can inform the evaluation of risk-adjustment and reinsurance as mechanisms to improve the functioning of small group health insurance markets. ..

..Our proposed endeavor will generate new knowledge for wide dissemination and publication that can inform future evidence-based PGR ethics guidelines and generate further empirical ethics research on PGR. ..

..Our proposed endeavor will generate new knowledge for wide dissemination and publication that can inform future evidence-based PGR ethics guidelines and generate further empirical ethics research on PGR. ..

..In addition, the award will provide a promising junior investigator a unique opportunity for career development in cancer research. ..

..During the last year of the study, she plans to apply for an R01 grant to set up a pilot clinical trial. ..

..Our goal is to develop a data set rich enough to support testing the WCG performance measures and their relationship to outcomes in states that represent larger and more diverse populations. ..

..Through the plan for development of my research career, I hope to contribute to the advancement of vital, ethically sound research involving mentally ill people and members of other special and potentially vulnerable, populations. ..

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..Evaluation will examine qualitative and quantitative data to measure the success of TECH-Net's implementation and to determine the impact on patient safety, cost, access to care and overall patient outcomes. ..

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