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Author: Todd Novak
Publisher: Fulton Books, Inc.
ISBN: 1649525869
Category : Education
Languages : en
Pages : 129
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Book Description
"When insurance companies can wield and abuse their power to alter prescriptions and dictate treatment decisions, this abuse erodes doctors' autonomy and undermines the mutual trust that is the foundation of the doctor-patient relationship. Doctors should be the primary voices for the course of action taken for their patients." Todd Novak, author "Health Insurance Denials: A Common American Death Story Exposed" shares the following: Denials of health claims that result in needless suffering and deaths Alarming statistics to support the part healthcare and pharmaceutical corporations play in this tragedy. Tricks of the trade by unscrupulous insurers to deny, delay, confuse and refuse legitimate claims. The deathblow of insurers rescinding or cancelling policies by finding loopholes that naive innocent people don't see. Government intervention constraints by the FDA that ties the hands of doctors who are hypersensitive to writing sorely needed prescriptions fearing loss of licensure. Court cases that provide hope for individuals Big Pharma's stranglehold on America Pharmacy benefit mangers (PBMs) monopoly that sets prices patients pay for skyrocketing prescription drugs. Drugstore chains "secret checklist" that causes a disproportionate number of Americans denial of prescriptions without cause or irrespective of their legitimacy. "Health Insurance Denials: A Common American Death Story Exposed" provides a solution to this problem with proposed "American Healthcare Act 101." This bill advocates a nonprofit health care system that will be supported and paid for by all business and corporations paying the same amount they pay now in health insurance premiums along with approximately three cents off each dollar that is now taken by payroll tax and Medicare tax. Other provisions include eliminating the stranglehold of big pharmaceutical companies and health insurance companies that disrupt the flow of medical necessity between doctor and patient.
Author: Todd Novak
Publisher: Fulton Books, Inc.
ISBN: 1649525869
Category : Education
Languages : en
Pages : 129
Get Book Here
Book Description
"When insurance companies can wield and abuse their power to alter prescriptions and dictate treatment decisions, this abuse erodes doctors' autonomy and undermines the mutual trust that is the foundation of the doctor-patient relationship. Doctors should be the primary voices for the course of action taken for their patients." Todd Novak, author "Health Insurance Denials: A Common American Death Story Exposed" shares the following: Denials of health claims that result in needless suffering and deaths Alarming statistics to support the part healthcare and pharmaceutical corporations play in this tragedy. Tricks of the trade by unscrupulous insurers to deny, delay, confuse and refuse legitimate claims. The deathblow of insurers rescinding or cancelling policies by finding loopholes that naive innocent people don't see. Government intervention constraints by the FDA that ties the hands of doctors who are hypersensitive to writing sorely needed prescriptions fearing loss of licensure. Court cases that provide hope for individuals Big Pharma's stranglehold on America Pharmacy benefit mangers (PBMs) monopoly that sets prices patients pay for skyrocketing prescription drugs. Drugstore chains "secret checklist" that causes a disproportionate number of Americans denial of prescriptions without cause or irrespective of their legitimacy. "Health Insurance Denials: A Common American Death Story Exposed" provides a solution to this problem with proposed "American Healthcare Act 101." This bill advocates a nonprofit health care system that will be supported and paid for by all business and corporations paying the same amount they pay now in health insurance premiums along with approximately three cents off each dollar that is now taken by payroll tax and Medicare tax. Other provisions include eliminating the stranglehold of big pharmaceutical companies and health insurance companies that disrupt the flow of medical necessity between doctor and patient.
Author: Scott Glovsky
Publisher:
ISBN: 9780692568828
Category :
Languages : en
Pages : 156
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Book Description
Health insurance companies claim to act in their customers' best interests, but quite often fail to deliver on that promise. In this step-by-step guide, health insurance attorney Scott Glovsky examines the lawyer's role in helping a client navigate a health insurance denial, from understanding consumer rights, the appeals process, independent medical review, through the intricacies of an insurance bad faith lawsuit, and how the Affordable Care Act has impacted health care law. Drawing from decades of experience from large firms and from his own private practice, Scott uses his unique client-centered approach to shed light on this important and often misunderstood practice area.
Author: John E. Dicken
Publisher: DIANE Publishing
ISBN: 143798312X
Category : Reference
Languages : en
Pages : 42
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Book Description
The large percentage of Americans that rely on private health insurance for health care coverage could expand with enactment of the Patient Protection and Affordable Care Act (PPACA) of 2010. Until PPACA is fully implemented, some consumers seeking coverage can have their applications for enrollment denied, and those enrolled may face denials of coverage for specific medical services. PPACA required this study of the rates of such application and coverage denials. The study reviewed the data available on denials of: (1) applications for enrollment; and (2) coverage for medical services. Charts and tables. This is a print on demand edition of an important, hard-to-find publication.
Author: U.s. Government Accountability Office
Publisher:
ISBN: 9781974640201
Category :
Languages : en
Pages : 42
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Book Description
"A large percentage of Americans that rely on private health insurance for health care coverage could expand with enactment of the Patient Protection and Affordable Care Act (PPACA) of 2010. Until PPACA is fully implemented, some consumers seeking coverage can have their applications for enrollment denied, and those enrolled may face denials of coverage for specific medical services. PPACA required GAO to study the rates of such application and coverage denials. GAO reviewed the data available on denials of (1) applications for enrollment and (2) coverage for medical services.GAO reviewed newly available nationwide data collected by the Department of Health and Human Services (HHS) from 459 insurers operating in the individual market on application denials from January through March 2010. GAO also reviewed a year or more of the available data from six states on the rates of application and coverage denials and the rates and outcomes of appeals related to coverage denials. The six states included all states identified by experts and in the literature as collecting data on the rates of application or coverage denials and together represented over 20 percent of private health insurance enrollment nationally. GAO conducted a literature review to identify studies related to application and coverage denials and reviewed..."
Author: Jay M. Feinman
Publisher: Penguin
ISBN: 1101196289
Category : Business & Economics
Languages : en
Pages : 241
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Book Description
An expose of insurance injustice and a plan for consumers and lawmakers to fight it Over the last two decades, insurance has become less of a safety net and more of a spider's web: sticky and complicated, designed to ensnare as much as to aid. Insurance companies now often try to delay payment of justified claims, deny payment altogether, and defend these actions by forcing claimants to enter litigation. Jay M. Feinman, a legal scholar and insurance expert, explains how these trends developed, how the government ought to fix the system, and what the rest of us can do to protect ourselves. He shows that the denial of valid claims is not occasional or accidental or the fault of a few bad employees. It's the result of an increasing and systematic focus on maximizing profits by major companies such as Allstate and State Farm. Citing dozens of stories of victims who were unfairly denied payment, Feinman explains how people can be more cautious when shopping for policies and what to do when pursuing a disputed claim. He also lays out a plan for the legal reforms needed to prevent future abuses. This exposé will help drive the discussion of this increasingly hot- button issue.
Author: AAPC
Publisher: AAPC
ISBN: 1626889821
Category : Medical
Languages : en
Pages : 16
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Book Description
Recoup lost time and revenue with denials management and appeals know-how. Claim denials can sink a profit margin. And given the cost of appeals, roughly $118 per claim, not all denials can be reworked. A practice submitting 50 claims a day at an average reimbursement rate of $200 per claim should bring in $10,000 in daily revenue. But if 10% of those claims are denied, and the practice can only appeal one, they lose $800 per day—upwards of $200K annually. Your medical claims are the lifeblood of operations. Don’t compromise your financial health. Learn how to preempt denials with the Denials Management & Appeals Reference Guide. This vital resource will equip you to get ahead of payers by simplifying the leading causes of denials and showing you how to address insufficient documentation, failing to establish medical necessity, coding and billing errors, coverage stipulations, and untimely filing. Rely on AAPC to walk you through the appeal process. We’ll help you establish protocols to avoid an appeals backlog and teach you how to identify and prioritize denials likely to win an appeal. What’s more, you’ll learn when a claim can be “reopened” to fix a problem. Collect the revenue your practice deserves with effective denials and appeals solutions: Know how to analyze your denials Defeat documentation and compliance issues for successful claims success Utilize payer policy for coverage clues Lock in revenue with face-to-face reimbursement guidance Refine efforts to avoid E/M claim denials Ace ICD-10 coding for optimum reimbursement Put an end to modifier confusion Stave off denials with CCI edits advice Navigate the appeals process like a pro And much more!
Author: Robert A. Peterson (Jr.)
Publisher:
ISBN: 9780932622501
Category : Health insurance
Languages : en
Pages : 118
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Book Description
Author: United States. Government Accountability Office
Publisher:
ISBN:
Category : Health insurance
Languages : en
Pages : 37
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Book Description
The large percentage of Americans that rely on private health insurance for health care coverage could expand with enactment of the Patient Protection and Affordable Care Act (PPACA) of 2010. Until PPACA is fully implemented, some consumers seeking coverage can have their applications for enrollment denied, and those enrolled may face denials of coverage for specific medical services. PPACA required GAO to study the rates of such application and coverage denials. GAO reviewed the data available on denials of (1) applications for enrollment and (2) coverage for medical services. GAO reviewed newly available nationwide data collected by the Department of Health and Human Services (HHS) from 459 insurers operating in the individual market on application denials from January through March 2010. GAO also reviewed a year or more of the available data from six states on the rates of application and coverage denials and the rates and outcomes of appeals related to coverage denials. The six states included all states identified by experts and in the literature as collecting data on the rates of application or coverage denials and together represented over 20 percent of private health insurance enrollment nationally. GAO conducted a literature review to identify studies related to application and coverage denials and reviewed data from selected studies. GAO interviewed HHS and state officials and researchers about factors to consider when interpreting the data.
Author: Kerm Henriksen
Publisher:
ISBN:
Category : Medical
Languages : en
Pages : 526
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Book Description
v. 1. Research findings -- v. 2. Concepts and methodology -- v. 3. Implementation issues -- v. 4. Programs, tools and products.
Author: Pam Waymack
Publisher: HC Pro, Inc.
ISBN: 9781578397112
Category : Business & Economics
Languages : en
Pages : 170
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Book Description
