This document provides information and guidance on obtaining insurance coverage for medical foods. It discusses understanding insurance policies and coverage, following state mandates, communicating with insurance carriers using the proper terminology, and removing exclusions. Tips are provided on requesting case managers, prior authorizations, and gap exceptions. The differences between medical and pharmacy benefits are explained. Assistance resources through Compassion*Works Medical and the NPKUA Insurance Coaches Program are outlined to help navigate the insurance process.
This document is a form for verifying treatment by an attending physician or other healthcare provider under New York's no-fault motor vehicle insurance law. The multi-page form requires information about the patient, diagnosis, treatment details, charges, and contains options for authorizing direct payment to the provider or assigning benefits to the provider. It collects essential details needed by the insurer to process no-fault insurance claims related to motor vehicle accidents.
Medical insurance covers unforeseen medical expenses like illness, injury, or accidents. It protects individuals and families in the same way other types of insurance like auto or homeowner's insurance provide protection. Medical costs have risen sharply in recent years. Private health insurance companies offer a variety of medical insurance plans that vary in coverage, costs, benefits, and complexity making it important for consumers to understand the differences between plans. Government programs also provide some forms of medical insurance coverage for specific groups.
Mrs. Richards will present on various topics related to the Affordable Care Act including the status of health insurance exchanges, grace periods for premium payments, and the future of premium tax credits. Data shows over 7 million have selected plans for 2015 on Healthcare.gov with most qualifying for subsidies. Region 5 states like Alabama, Florida, Georgia, South Carolina and Tennessee saw hundreds of thousands of new enrollees. The Supreme Court will hear a case on whether subsidies can be used on federal exchanges. Mrs. Richards is an attorney who specializes in third party healthcare reimbursement and is a fellow of HFMA.
This document defines various health insurance terms used in the Affordable Care Act and Washington state programs. It provides definitions for over 50 terms related to health plans, coverage, costs, eligibility and other key concepts. The document is intended to help consumers understand and navigate their health insurance options.
This document defines various key terms related to health insurance:
1. It describes an actuary as an insurance professional responsible for determining premiums based on claims paid versus premiums collected to ensure profits.
2. It provides brief definitions for terms like admitting privilege, affordable care act, agent, beneficiary, benefit, brand name drug, broker, carrier, case management, certificate of insurance, claim, and COBRA.
3. It explains concepts such as coinsurance, copayment, credit for prior coverage, deductible, denial of claim, dependent, effective date, exclusion, explanation of benefits, fee for service, generic drug, group health insurance, and guaranteed issue.
Understanding the ObamaCare North Carolina Health Insurance Plans
As a result of the Affordable Care Act (a.k.a. ObamaCare) the following provisions are now in place for health insurance policies with an effective date January 1, 2014 or after:Individuals cannot be declined for health insurance or charged more due to their health status or gender.
Insurance premiums are based on age, your zip code and tobacco usage.
Coverage limitations or exclusions based on pre-existing conditions are not allowed.
Elimination of annual and lifetime coverage limits.
Prohibition of declining an individual for coverage based on their participation in an approved clinical trial.
Maternity and mental health are included on all policies.
Preventative dental is covered with a $25 copay for members up to age 19. There is also some vision coverage for this age group.
Whether or not your children are students they can stay on your policy until age 26.
Introduction of the Medical Loss Ratio (MLR) which ensures that 80% of the premium dollars paid to the health insurance issuer are spend on providing health care. An insurance company that does not do this must provide rebates to their policyholders
http://www.hisonc.com/obamacare-north-carolina
Billing and Reimbursement for Surgical Assistants - How to startLuis F. Aragon
A basic guide of what you need to know if you are looking into going into private practice as a non-physician surgical assistant in regards to third party billing.
This document provides a glossary of terms related to individual health insurance. It defines terms like agent, annual deductible, coinsurance, network providers, pre-existing conditions, and premiums. It also provides contact information for Celtic Insurance Company, an individual health insurance provider. Celtic aims to offer consumers affordable and easy-to-understand insurance plans. The glossary helps explain insurance concepts and Celtic's services.
This document is a form for verifying treatment by an attending physician or other healthcare provider under New York's no-fault motor vehicle insurance law. The multi-page form requires information about the patient, diagnosis, treatment details, charges, and contains options for authorizing direct payment to the provider or assigning benefits to the provider. It collects essential details needed by the insurer to process no-fault insurance claims related to motor vehicle accidents.
Medical insurance covers unforeseen medical expenses like illness, injury, or accidents. It protects individuals and families in the same way other types of insurance like auto or homeowner's insurance provide protection. Medical costs have risen sharply in recent years. Private health insurance companies offer a variety of medical insurance plans that vary in coverage, costs, benefits, and complexity making it important for consumers to understand the differences between plans. Government programs also provide some forms of medical insurance coverage for specific groups.
Mrs. Richards will present on various topics related to the Affordable Care Act including the status of health insurance exchanges, grace periods for premium payments, and the future of premium tax credits. Data shows over 7 million have selected plans for 2015 on Healthcare.gov with most qualifying for subsidies. Region 5 states like Alabama, Florida, Georgia, South Carolina and Tennessee saw hundreds of thousands of new enrollees. The Supreme Court will hear a case on whether subsidies can be used on federal exchanges. Mrs. Richards is an attorney who specializes in third party healthcare reimbursement and is a fellow of HFMA.
This document defines various health insurance terms used in the Affordable Care Act and Washington state programs. It provides definitions for over 50 terms related to health plans, coverage, costs, eligibility and other key concepts. The document is intended to help consumers understand and navigate their health insurance options.
This document defines various key terms related to health insurance:
1. It describes an actuary as an insurance professional responsible for determining premiums based on claims paid versus premiums collected to ensure profits.
2. It provides brief definitions for terms like admitting privilege, affordable care act, agent, beneficiary, benefit, brand name drug, broker, carrier, case management, certificate of insurance, claim, and COBRA.
3. It explains concepts such as coinsurance, copayment, credit for prior coverage, deductible, denial of claim, dependent, effective date, exclusion, explanation of benefits, fee for service, generic drug, group health insurance, and guaranteed issue.
Understanding the ObamaCare North Carolina Health Insurance Plans
As a result of the Affordable Care Act (a.k.a. ObamaCare) the following provisions are now in place for health insurance policies with an effective date January 1, 2014 or after:Individuals cannot be declined for health insurance or charged more due to their health status or gender.
Insurance premiums are based on age, your zip code and tobacco usage.
Coverage limitations or exclusions based on pre-existing conditions are not allowed.
Elimination of annual and lifetime coverage limits.
Prohibition of declining an individual for coverage based on their participation in an approved clinical trial.
Maternity and mental health are included on all policies.
Preventative dental is covered with a $25 copay for members up to age 19. There is also some vision coverage for this age group.
Whether or not your children are students they can stay on your policy until age 26.
Introduction of the Medical Loss Ratio (MLR) which ensures that 80% of the premium dollars paid to the health insurance issuer are spend on providing health care. An insurance company that does not do this must provide rebates to their policyholders
http://www.hisonc.com/obamacare-north-carolina
Billing and Reimbursement for Surgical Assistants - How to startLuis F. Aragon
A basic guide of what you need to know if you are looking into going into private practice as a non-physician surgical assistant in regards to third party billing.
This document provides a glossary of terms related to individual health insurance. It defines terms like agent, annual deductible, coinsurance, network providers, pre-existing conditions, and premiums. It also provides contact information for Celtic Insurance Company, an individual health insurance provider. Celtic aims to offer consumers affordable and easy-to-understand insurance plans. The glossary helps explain insurance concepts and Celtic's services.
This document provides an overview and summary of Medicare and supplemental insurance options. It begins with introducing Boone Insurance Associates, which provides various health and life insurance products. The bulk of the document then summarizes Medicare Parts A, B, C, and D - including what they cover, who qualifies, premium and cost-sharing details. It also discusses options for covering gaps in Medicare like Medicare Advantage plans, Medigap plans, and Part D prescription drug plans. Specific plan types like HMOs, PPOs, and POS plans are defined.
Advanced Strategies for Trial Attorneys: Resolve Liens, Ensure Medicare Compl...SynergySettlementServices
A complimentary and quick-hitting webinar covering some of the most complex issues that trial attorneys face when resolving catastrophic personal injury cases. Our panel of national experts will share tips & techniques along with best practices to make sure your firm and its clients are protected against common potential malpractice mistakes.
An electronic remittance advice (ERA) is an electronic explanation of payment from an insurance company. It explains the amount allowed by the insurer, amount paid, and any other payers. An ERA provides insurance company information, patient details, claim statuses, procedure codes, charged/allowed/paid amounts, deductibles, coinsurance, and adjustment codes. It allows providers to reconcile payments and determine responsibilities. Questions can be directed to Brett Jones or Sean Mullen of Health Assets Management, Inc.
The Art of Practice Management Dental Pearls - October 2016Marianne Harper
An insightful and informative newsletter from the Art of Practice Management. A dental practice management consulting company that focuses on revenue and collection systems, front desk systems and forms, dental insurance processing, medical/dental cross-coding systems and employment-law compliance.
This document summarizes information about Medicare coverage options. It discusses who is eligible for Medicare and what Parts A and B cover. It also describes supplemental plans like Medigap and Medicare Advantage plans, noting their benefits and costs. Examples are provided to illustrate out-of-pocket expenses under different coverage options. The summary concludes that having original Medicare with a Medigap plan and Part D prescription drug coverage provides the most comprehensive coverage at the lowest cost, but a Medicare Advantage plan may also be suitable depending on individual needs and circumstances.
UnitedHealthcare Insurance Company has partnered with AARP to offer AARP Medicare Supplement Insurance Plans to individuals enrolled in Medicare Parts A and B. The plans are designed to help cover costs that Original Medicare does not cover, such as copays, coinsurance, and deductibles. They provide coverage for medically necessary care and offer member services. Customers consistently report high levels of satisfaction with the benefits and coverage provided by the AARP Medicare Supplement Insurance Plans.
Short-term care insurance (STCI) provides more affordable nursing home coverage than long-term care insurance, with lower premiums, simpler application processes, and benefits that restore fully after six months without care. The document outlines the benefits of Bankers Fidelity's STCI policies, which cover nursing home costs for up to 360 days per confinement and have flexible daily benefit and policy duration options. STCI is a valuable option for seniors and their families to manage the high costs of nursing home care for shorter stays.
This document summarizes a policy brief on Explanation of Benefits (EOBs) and patient confidentiality. It discusses the tension between maintaining patient confidentiality, especially for adolescents and young adults seeking sensitive health services, and insurers' practice of sending EOBs to notify policyholders of medical claims and costs. While EOBs aim to prevent fraud, they can compromise confidentiality by revealing details of services received. The brief reviews legal contexts, case studies, and strategies to balance these competing priorities in light of expanding health insurance coverage under the Affordable Care Act. It describes a methodology involving interviews with 37 health care experts to inform potential policy solutions.
US healthcare insurance can be public (e.g. Medicare, Medicaid) or private (employer or self-purchased plans). Medicare has parts A, B, C, and D that cover different services like hospitals (Part A) and prescription drugs (Part D). Plans may require premiums, deductibles, co-payments, or co-insurance. They often have limits and do not cover all costs. Private insurers provide additional plans like PPOs, HMOs, or Medicare Advantage plans combining Part A, B, and D benefits. SCHIP provides coverage for children from families that do not qualify for Medicaid.
Max Bupa Health Insurance Brief PPT assignmentNavneet Jingar
Max Bupa Health Insurance is a joint venture between Max India and UK-based Bupa. It provides various individual and family health insurance policies like Heart Beat, Family First, and Family Floater. Privatization of insurance was needed for faster expansion, more funds for the government, and more employment opportunities. Max Bupa focuses on customer service, uses various promotion channels, and has processes for approving and paying claims. It operates with integrity and customer focus.
This document defines various terms related to health insurance and disability insurance. It provides definitions for terms like HMO, experience rating, fraud, guaranteed renewable, exclusion rider, express authority, fully insured, hazard, disability income insurance, elimination period, presumptive disability benefit, noncancelable renewal provision, nonscheduled plan, offer, own occupation, nondisabling injury, notice of claims provision, partial disability, open-panel HMO, Medicare parts A, B, D, misstatement of age or sex provision, multiple employer trust, morbidity, National Association of Insurance Commissioners, Medical Information Bureau, major medical expense policy, Lloyd's of London, legal purpose, managed care organization, long-term care, limited policies, ins
The document discusses the Affordable Care Act and healthcare marketplace options. It provides information about subsidies, plan types (Bronze, Silver, Gold, Platinum), open enrollment periods, and common questions about the ACA and enrollment. Key points covered include that the ACA aims to expand coverage to 32 million Americans, offers subsidies to offset premium costs, prohibits denying coverage or limiting benefits due to pre-existing conditions, and sets minimum coverage standards. The open enrollment period for 2015 plans runs from November 15, 2014 to February 15, 2015.
Read the latest benefits information from Independent Medicare broker Erin Hart from American HealthCare Group. Learn about Medicare income limits, care plans, and topics to consider when planning for health benefits in retirement.
The health care reform law calls for the creation of state-based insurance Exchanges. This Legislative Brief provides an overview of state progress toward creating the Exchanges and the role of entities typically involved with the insurance placement process (such as brokers and agents) under the Exchanges. It also discusses the emergence of private health insurance Exchanges.
This document compares Medicare Advantage plans and Medigap plans. Medicare Advantage plans are offered by private insurers and provide the same benefits as traditional Medicare, often with additional benefits. Medigap plans supplement traditional Medicare by covering costs like deductibles and copays. While Medigap may be more expensive due to monthly premiums, it offers more flexibility to see any doctor. Medicare Advantage can be cheaper for some but has more restrictions on doctors and less predictability in costs. In the end, the best option depends on one's priorities around cost, flexibility, and ability to handle financial risk.
Health Insurance, the ACA, and HomelessnessAlex Bonte
The document provides an overview of health insurance, the Affordable Care Act, and how they relate to homelessness. It discusses key points including why health insurance is important, the major public insurance programs of Medicare and Medicaid/Medi-Cal, how the Affordable Care Act expanded access to coverage, and options for uninsured homeless individuals through Medi-Cal or Covered California. It also outlines services provided by the Berkeley Free Clinic to help enroll eligible homeless individuals in coverage plans.
Philip Eskew, DO, JD, MBA - Legal Risk Mitigation for DPC Physicians - DPC Su...Hint
This document discusses legal risk mitigation for physicians practicing direct primary care (DPC). It begins with disclaimers about the content being for educational purposes only and that performance data from DPC practices is only for illustration. It then covers understanding recent state laws defining DPC as "not insurance", patients' rights to pricing transparency under HIPAA, and questions around opting out of Medicare. The document also provides definitions of DPC, examples of state enforcement actions, and top ten suggestions for states to reduce legal risk as a DPC practice.
This document describes research on developing a stochastic model of zebrafish locomotion from experimental tracking data. The researchers:
1) Collected tracking data from videos of isolated zebrafish swimming in tanks to analyze their speed, turning, and interactions with walls over time.
2) Developed a stochastic differential equation model with coupled processes for speed and turning speed to reproduce the fish's motion characteristics.
3) Extended the model to include a coupling function representing how turning speed is affected by speed to better match the experimental speed-turning correlation.
4) Began exploring a multi-agent extension of the model to capture interactions between pairs of fish based on preliminary analysis of social forces between fish swimmers.
This document summarizes a presentation given by Angel Melguizo at the OECD Task Force on Tax and Development about factors that influence tax morale. It discusses how tax morale is affected by perceptions of corruption, trust in government, satisfaction with public services, and support for democracy based on analyses of surveys in Africa, Asia, and Latin America. Higher tax morale is associated with lower perceived corruption, greater trust in government, higher satisfaction with healthcare, education, and social services, and more support for democracy. More data and research is still needed to better measure and understand tax morale across different countries and regions.
This document provides an overview and summary of Medicare and supplemental insurance options. It begins with introducing Boone Insurance Associates, which provides various health and life insurance products. The bulk of the document then summarizes Medicare Parts A, B, C, and D - including what they cover, who qualifies, premium and cost-sharing details. It also discusses options for covering gaps in Medicare like Medicare Advantage plans, Medigap plans, and Part D prescription drug plans. Specific plan types like HMOs, PPOs, and POS plans are defined.
Advanced Strategies for Trial Attorneys: Resolve Liens, Ensure Medicare Compl...SynergySettlementServices
A complimentary and quick-hitting webinar covering some of the most complex issues that trial attorneys face when resolving catastrophic personal injury cases. Our panel of national experts will share tips & techniques along with best practices to make sure your firm and its clients are protected against common potential malpractice mistakes.
An electronic remittance advice (ERA) is an electronic explanation of payment from an insurance company. It explains the amount allowed by the insurer, amount paid, and any other payers. An ERA provides insurance company information, patient details, claim statuses, procedure codes, charged/allowed/paid amounts, deductibles, coinsurance, and adjustment codes. It allows providers to reconcile payments and determine responsibilities. Questions can be directed to Brett Jones or Sean Mullen of Health Assets Management, Inc.
The Art of Practice Management Dental Pearls - October 2016Marianne Harper
An insightful and informative newsletter from the Art of Practice Management. A dental practice management consulting company that focuses on revenue and collection systems, front desk systems and forms, dental insurance processing, medical/dental cross-coding systems and employment-law compliance.
This document summarizes information about Medicare coverage options. It discusses who is eligible for Medicare and what Parts A and B cover. It also describes supplemental plans like Medigap and Medicare Advantage plans, noting their benefits and costs. Examples are provided to illustrate out-of-pocket expenses under different coverage options. The summary concludes that having original Medicare with a Medigap plan and Part D prescription drug coverage provides the most comprehensive coverage at the lowest cost, but a Medicare Advantage plan may also be suitable depending on individual needs and circumstances.
UnitedHealthcare Insurance Company has partnered with AARP to offer AARP Medicare Supplement Insurance Plans to individuals enrolled in Medicare Parts A and B. The plans are designed to help cover costs that Original Medicare does not cover, such as copays, coinsurance, and deductibles. They provide coverage for medically necessary care and offer member services. Customers consistently report high levels of satisfaction with the benefits and coverage provided by the AARP Medicare Supplement Insurance Plans.
Short-term care insurance (STCI) provides more affordable nursing home coverage than long-term care insurance, with lower premiums, simpler application processes, and benefits that restore fully after six months without care. The document outlines the benefits of Bankers Fidelity's STCI policies, which cover nursing home costs for up to 360 days per confinement and have flexible daily benefit and policy duration options. STCI is a valuable option for seniors and their families to manage the high costs of nursing home care for shorter stays.
This document summarizes a policy brief on Explanation of Benefits (EOBs) and patient confidentiality. It discusses the tension between maintaining patient confidentiality, especially for adolescents and young adults seeking sensitive health services, and insurers' practice of sending EOBs to notify policyholders of medical claims and costs. While EOBs aim to prevent fraud, they can compromise confidentiality by revealing details of services received. The brief reviews legal contexts, case studies, and strategies to balance these competing priorities in light of expanding health insurance coverage under the Affordable Care Act. It describes a methodology involving interviews with 37 health care experts to inform potential policy solutions.
US healthcare insurance can be public (e.g. Medicare, Medicaid) or private (employer or self-purchased plans). Medicare has parts A, B, C, and D that cover different services like hospitals (Part A) and prescription drugs (Part D). Plans may require premiums, deductibles, co-payments, or co-insurance. They often have limits and do not cover all costs. Private insurers provide additional plans like PPOs, HMOs, or Medicare Advantage plans combining Part A, B, and D benefits. SCHIP provides coverage for children from families that do not qualify for Medicaid.
Max Bupa Health Insurance Brief PPT assignmentNavneet Jingar
Max Bupa Health Insurance is a joint venture between Max India and UK-based Bupa. It provides various individual and family health insurance policies like Heart Beat, Family First, and Family Floater. Privatization of insurance was needed for faster expansion, more funds for the government, and more employment opportunities. Max Bupa focuses on customer service, uses various promotion channels, and has processes for approving and paying claims. It operates with integrity and customer focus.
This document defines various terms related to health insurance and disability insurance. It provides definitions for terms like HMO, experience rating, fraud, guaranteed renewable, exclusion rider, express authority, fully insured, hazard, disability income insurance, elimination period, presumptive disability benefit, noncancelable renewal provision, nonscheduled plan, offer, own occupation, nondisabling injury, notice of claims provision, partial disability, open-panel HMO, Medicare parts A, B, D, misstatement of age or sex provision, multiple employer trust, morbidity, National Association of Insurance Commissioners, Medical Information Bureau, major medical expense policy, Lloyd's of London, legal purpose, managed care organization, long-term care, limited policies, ins
The document discusses the Affordable Care Act and healthcare marketplace options. It provides information about subsidies, plan types (Bronze, Silver, Gold, Platinum), open enrollment periods, and common questions about the ACA and enrollment. Key points covered include that the ACA aims to expand coverage to 32 million Americans, offers subsidies to offset premium costs, prohibits denying coverage or limiting benefits due to pre-existing conditions, and sets minimum coverage standards. The open enrollment period for 2015 plans runs from November 15, 2014 to February 15, 2015.
Read the latest benefits information from Independent Medicare broker Erin Hart from American HealthCare Group. Learn about Medicare income limits, care plans, and topics to consider when planning for health benefits in retirement.
The health care reform law calls for the creation of state-based insurance Exchanges. This Legislative Brief provides an overview of state progress toward creating the Exchanges and the role of entities typically involved with the insurance placement process (such as brokers and agents) under the Exchanges. It also discusses the emergence of private health insurance Exchanges.
This document compares Medicare Advantage plans and Medigap plans. Medicare Advantage plans are offered by private insurers and provide the same benefits as traditional Medicare, often with additional benefits. Medigap plans supplement traditional Medicare by covering costs like deductibles and copays. While Medigap may be more expensive due to monthly premiums, it offers more flexibility to see any doctor. Medicare Advantage can be cheaper for some but has more restrictions on doctors and less predictability in costs. In the end, the best option depends on one's priorities around cost, flexibility, and ability to handle financial risk.
Health Insurance, the ACA, and HomelessnessAlex Bonte
The document provides an overview of health insurance, the Affordable Care Act, and how they relate to homelessness. It discusses key points including why health insurance is important, the major public insurance programs of Medicare and Medicaid/Medi-Cal, how the Affordable Care Act expanded access to coverage, and options for uninsured homeless individuals through Medi-Cal or Covered California. It also outlines services provided by the Berkeley Free Clinic to help enroll eligible homeless individuals in coverage plans.
Philip Eskew, DO, JD, MBA - Legal Risk Mitigation for DPC Physicians - DPC Su...Hint
This document discusses legal risk mitigation for physicians practicing direct primary care (DPC). It begins with disclaimers about the content being for educational purposes only and that performance data from DPC practices is only for illustration. It then covers understanding recent state laws defining DPC as "not insurance", patients' rights to pricing transparency under HIPAA, and questions around opting out of Medicare. The document also provides definitions of DPC, examples of state enforcement actions, and top ten suggestions for states to reduce legal risk as a DPC practice.
This document describes research on developing a stochastic model of zebrafish locomotion from experimental tracking data. The researchers:
1) Collected tracking data from videos of isolated zebrafish swimming in tanks to analyze their speed, turning, and interactions with walls over time.
2) Developed a stochastic differential equation model with coupled processes for speed and turning speed to reproduce the fish's motion characteristics.
3) Extended the model to include a coupling function representing how turning speed is affected by speed to better match the experimental speed-turning correlation.
4) Began exploring a multi-agent extension of the model to capture interactions between pairs of fish based on preliminary analysis of social forces between fish swimmers.
This document summarizes a presentation given by Angel Melguizo at the OECD Task Force on Tax and Development about factors that influence tax morale. It discusses how tax morale is affected by perceptions of corruption, trust in government, satisfaction with public services, and support for democracy based on analyses of surveys in Africa, Asia, and Latin America. Higher tax morale is associated with lower perceived corruption, greater trust in government, higher satisfaction with healthcare, education, and social services, and more support for democracy. More data and research is still needed to better measure and understand tax morale across different countries and regions.
The document provides initial ideas and drawings about Native Americans from the perspective of children. It lists observations such as Native Americans hunting with bows and arrows in the mountains and parks, wearing feathers in their hair, and having their legs in a crossed position. Other observations include living in tents with fires outside, wearing colorful feathered clothing and large pants, and using canoes with two oars for transportation.
As government reduces funding to local government, the county council has to continue to make budget savings. At the same time demand for our services is increasing, partly due to our ageing and growing population, and increasing demand for children’s social care services is going up. Read more about the background to our proposed budget savings.
This document contains information about a course instructor, group number, and group members for a class project on Long Term Evolution (LTE) network architecture. It lists the instructor, Rethwan Faiz, the group number 1, and the 6 student members of the group along with their student IDs. It concludes with mentioning the topic of LTE architecture and wishing the reader to have a nice day.
This document outlines the requirements for a statistics project assigned to students. It instructs students to work in groups of 4-5 members to conduct a survey comparing understanding of a chronic disease between male and female students. The survey must include at least 15 questions and interview a minimum of 200 targets. Students must analyze and present the survey results in a report, poster, and completed survey forms. The project aims to provide hands-on experience collecting and analyzing statistical data. Assessment will consider understanding of comparative surveys, statistical analysis skills, communication skills, and individual contribution.
Talk given at the 2015 Fall Regional in Oshkosh WI.
"An Approach to Address Parsing and Data Standardization"
Abstract:
Maintaining fully parsed address elements in your database can be one of the most beneficial steps toward
achieving quality and consistency in addressing. Parsed address elements also serve a preparatory step in
modeling an address toward NG9-1-1 supporting formats such as the FGDC address standard. In this talk,
we’ll take a look at the approach we’ve used for parsing site addresses for the V1 Statewide Parcel Map, the
role regular expressions played in this approach, and will unveil a suite of (free) ArcPy tools that can help you
parse addresses, standardize field values, and achieve other tasks.
Presenters:
Codie See
David Vogel
Muhammed Shafeeq is seeking a challenging opportunity that offers career growth. He has over 5 years of experience in translation, administrative work, and legal documentation. He is fluent in English, Arabic, Persian, Hindi, and Malayalam. Currently he works as a legal translator and interpreter in Doha, Qatar, where he translates various legal and government documents. He previously worked as a translator and HR administrator in Dubai, where he translated documents and handled visa processing. He has a Master's degree in English Literature, Urdu Literature, and Islamic Studies.
Hunting involves legally or illegally killing animals by chasing them. Historically, animals were hunted for food or trade, while today some hunt for entertainment or to sell animal parts. Hunters argue that hunting balances animal populations, generates money for conservation, and creates a connection with nature. However, critics note that missed shots can injure animals, and hunting disrupts natural behaviors. While laws aim to regulate hunting, endangered species remain at risk of illegal hunting.
Yorston & Associates is a manufacturer representative and consultant firm that has been serving the sign industry since 1986. They aim to unlock potential for their clients by promoting innovation, efficiency, and growth. As the "lynchpin" in the sign industry, they work with both designers and specifiers. Yorston & Associates provides manufacturer support through their extensive distribution network across North America, experienced representative team with over 150 years of combined industry experience, and various services to support manufacturers and bring them to distributors.
SACADA is a nonprofit that has served over 60,000 children and adults in Bexar County since 1957 through prevention, intervention, and recovery programs for substance abuse issues. Their annual Red Ribbon Rally will have over 6,000 children attend concerts by the Air Force Band of the West this week. In 2014-2015, their Project Heart youth prevention programs served 4,600 children and saw increases in self-esteem, decision making, academics, and social skills for 87% of participants. Their Little Warriors Camp provided free summer programming for 190 children of military families. Testimonials from students and clients showed how SACADA's services helped improve behaviors, life skills, and supported recovery.
The document discusses different genres of thriller films, including action thrillers, horror thrillers, psychological thrillers, crime thrillers, erotic thrillers, torture porn, and techno thrillers. Action thrillers involve heroes, villains, weapons and fighting. Horror thrillers create fear through conflicts with monsters. Psychological thrillers focus on mental conflict and use of the mind. Crime thrillers concentrate on the impact of crimes and tracking down criminals. Erotic thrillers combine elements of thrillers and eroticism. Torture porn graphically depicts gore and violence. Techno thrillers involve military technology and speculation about future wars.
Wicker Park is a neighborhood in Chicago located west of downtown. It has a population of around 13,778 people, with a median household income of $83,396. Originally built in 1868, Wicker Park was first settled by Germans and Norwegians, and later Polish immigrants. Today, it is known as an artistic neighborhood with hipster culture, featuring attractions like art museums, street festivals, and vintage shops. Walking through Wicker Park gave the students an authentic experience of Chicago's diverse and artistic communities.
Sunflower seed oil has potential as a biofuel feedstock because sunflowers have high oil content over 40% and can yield 35-80 gallons of oil per acre. Sunflowers are easy to grow in a variety of conditions with established agricultural practices. While sunflower oil is primarily used for food, it could offset diesel fuel use on farms. However, sunflower oil may not provide adequate economic returns as a biodiesel feedstock in major oil-producing regions where it fetches a high price as food.
Freelance 3D visualizer - Exhibition Stands, Podiums, Kiosk EtcAshhad Karim
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
This short document contains photos credited to various photographers and encourages the reader to create their own Haiku Deck presentation on SlideShare by providing a link to get started. It uses a series of photos without captions to visually break up the text and draw attention to the call to action to get started making a presentation.
- Medical billing companies handle the process of submitting claims to insurance companies and getting paid for physicians' services, as the process is lengthy, complicated, and involves many rules and regulations.
- There are three main parties in medical billing - the physician, the insurance company, and the patient. Medical billing companies work to maximize collections for physicians while complying with insurance company rules and not penalizing patients.
- The main functions of medical billing companies are to process patient information and file claims with private insurance companies and government programs like Medicare and Medicaid in order to get healthcare providers paid on time.
I don't understand my marketplace insuranceSteve Levine
Half a year after policies purchased via the Affordable Care Act (ACA) online marketplace exchanges first took effect, research studies and media reports show that many of these newly insured Americans don’t understand their insurance or how to use it.
“Hey Doc” is pleased to reissue some of our articles and videos to help answer some critical questions.
This document provides information about supplementing Medicare coverage. It discusses major gaps in Medicare coverage, types of supplemental insurance policies like Medigap plans, consumer protections, filing claims, and illegal sales practices to watch out for. It emphasizes reading policies carefully, comparing options from multiple insurers, and verifying a policy and company are legitimate before purchasing supplemental insurance.
Enjoy Chapter 1 of our E-Book, "The Ultimate Guide to Paying for Therapy In Georgia!" Visit http://www.thegeorgecenter.com/the-ultimate-guide-to-paying-for-therapy-in-georgia/ to download the whole book and learn how to get the most out of your insurance coverage.
#2 What is voluntary insurance why do employees need itThomas C. Williams
Voluntary insurance provides additional coverage to employees to help pay medical and living expenses not covered by major medical insurance. It is not required but is completely optional for employees to enroll in. Many employees are interested in voluntary insurance because nearly half have less than $1,000 to pay out-of-pocket medical costs, and two-thirds would struggle with the costs of a serious injury or illness. Voluntary insurance can help employees pay deductibles, coinsurance, copays, and bills that continue after an illness or injury when someone cannot work. It benefits both employees and employers by providing financial protection for employees with no direct cost to companies.
Although the Affordable Care Act has benefited the health insurance consumer in many respects, it has also added to the confusion. This presentation, Given by Wanda Stephens in Raleigh, North Carolina, details some of the many facets to Obamacare in NC.
for more information visit http://www.hisonc.com/obamacare-north-carolina/
Here are 7 Health Insurance Questions, Answered: 1. What Is Health Insurance? 2. Why Do I Need Health Insurance? 3. What Are the Different Types of Health Insurance? 4. What Is a Premium, Deductible, and Copayment?
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Similar to NPKUA July Presentaion Slides (revised2) (20)
3. INTRODUCTION
Raenette Franco, CEO, CBCS
Certified Medical Biller Coder Specialist
and Patient Advocate
Founder of
Compassion*Works Medical, LLC
3
Disclosure: This presentation is presented for the NPKUA insurance coaching
program and created by Compassion Works Medical, LLC®. The information
provided is not related and/or currently in any conflict of interests bounded by outside
business breaching.
5. STEPS TO INSURANCE COVERAGE FOR
MEDICAL FOODS
Understanding your insurance coverage and policy.
Gap exceptions/Out of network referrals.
Assigned case manager from your insurance carrier.
Following State mandates for fully insured policies.
Medical food exclusion removals from employers.
Tools and Resources.
Insurance terminology.
Medicare and Medicaid advice.
Understanding EOB’s.
Difference between Medical Food benefits
and Pharmacy benefits.
5
6. UNDERSTANDING YOUR INSURANCE
COVERAGE AND POLICY (PART 1)
What is Creditable Coverage? Creditable Coverage
provides policy guidance and benefit information from
any public or private health insurance or health benefits
plan, whether insured or self-insured.
Read through your Creditable Coverage policy for an
accurate description of medical food/formula benefits
before calling your insurance carrier for questions.
Key words: ENTERAL, MEDICAL FOODS, NUTRITION,
METABOLIC
HCPCS Codes: B4155, B4157, B4162, B9998, S9435
6
7. UNDERSTANDING YOUR INSURANCE
COVERAGE AND POLICY (PART 2)
In-network: Providers that participate with your
plan.
Out-of-network: Providers that do not participate
with your plan.
Tip: Staying inside your network means smaller
copays and full coverage. If you choose to go
outside your network, you'll have higher out-of-
pocket costs, and not all services may be
covered. 7
8. UNDERSTANDING YOUR INSURANCE
COVERAGE AND POLICY (PART 3)
Deductible: Amount that you must pay before
the insurance kicks in.
Out-of-Pocket: A predetermined amount of
money for a chance to increase your insurance
to 100%. It can be a bit confusing with the
deductible. The good news is that you don’t have
to meet any amount before your coverage kicks
in. Sometimes confused with deductible.
8
9. UNDERSTANDING YOUR INSURANCE COVERAGE AND
POLICY (PART 4)
What is a Pre-certification also known as
Prior authorization?
Pre-certification serves as a utilization
management tool, allowing payment for
services and procedures that are
medically necessary, appropriate and
cost-effective without compromising the
quality of care to you.
Pre-certification for medical foods must
be approved before your insurance will
cover.
9
10. UNDERSTANDING YOUR INSURANCE
COVERAGE AND POLICY (FINAL PART)
Questions and support?
Compassion*Works Medical together with
the National PKU Alliance can support you
through our insurance coaching and patient
advocacy program.
10
11. 11
HOLDING HANDS TO THE NEXT STEPS
“GAP EXCEPTIONS AND ASSIGNED CASE MANGERS”
12. GAP EXCEPTIONS/OUT OF NETWORK REFERRALS
What is a Gap Exception? It is asking permission
from your insurance carrier to use a particular
provider that is out-of-network and getting the same
benefits as the in-network level.
How can I request for a Gap Exception? Usually
your out-of-network provider will make the request. It
is based on no other comparable providers that can
provide the requested service within 30 miles of your
residence proximity.
12
13. ASSIGNED CASE MANAGER FROM YOUR
INSURANCE CARRIER
A system of coordinating medical services to *treat a
patient, *improve care and *reduce cost. A case manager
coordinates health care delivery for patients.
How do I request for an assigned case manager from
my insurance carrier for my medical foods?
Answer: Contact member services then ask for the
utilization management department. Once you’re
connected, ask for an assigned case manager and
explain that you have an inborn error of metabolism
disease and need long term assistance.
13
14. HOLDING HANDS TO THE NEXT STEPS
“FOLLOWING STATE MANDATES &
MEDICAL FOOD EXCLUSION REMOVAL”
14
15. FOLLOWING STATE MANDATES FOR FULLY INSURED
POLICIES (PART 1)
How do I know if my State has a mandate?
Answer: You can check the NPKUA website to
determine if your state has a mandate.
http://www.npkua.org/TakeAction/StateCoverage.as
px.
Every state has their own laws. Few have
deductible and co-pay waivers that helps a great
deal without paying out of pocket to get coverage
before insurance kick in! Some have an annual
maximum (i.e. $2,500, etc.).
15
16. FOLLOWING STATE MANDATES FOR FULLY
INSURED POLICIES (PART 2)
If I am in a state with a deductible waiver, how can I
get my insurance carrier to ride-off the deductible?
Answer: The good news is that some insurance
carriers already follows their mandate After
verification of benefits they will make a note on your
policy and create a rider.
What is a Rider?
Answer: A rider is an amendment to
an insurance policy.
16
17. FOLLOWING STATE MANDATES FOR FULLY
INSURED POLICIES (FINAL PART )
If a policy is unaware of your state mandate, you
should send them a copy of the law to create any
riders. (i.e. deductibles, medical exclusions, etc.).
Advice: Print out a copy of your state mandate
from the NPKUA website and keep for insurance
assistance.
17
18. 18
HOLDING HANDS TO THE
NEXT STEPS
“INSURANCE TERMINOLOGY
AND MEDICAL FOOD
EXCLUSION REMOVAL”
19. WHAT IS THE PROPER INSURANCE
TERMINOLOGY?
Without knowing the proper insurance terminology,
understanding your insurance coverage for Medical
Foods/Enteral Formula can be confusing and
frustrating.
Let’s learn a few simple questions to ask and
words…….
19
20. HOW DO I COMMUNICATE WITH MY
INSURANCE CARRIER?
20
What is my coverage for Medical
Foods and Enteral Formula?
I have service codes that I will like to
check? (B4157, B4162 (pediatric),
S9434, S9435). A service code also
known as HCPCS/CPT code is the
description of the medical food
service.
21. HOW DO I COMMUNICATE WITH MY
INSURANCE CARRIER?
What is my deductible (if any)?
Has my deducible been met?
What is the allowed amount on my
plan?
21
22. HOW DO I COMMUNICATE WITH MY
INSURANCE CARRIER?
Is my plan fully insured or self funded? This could
help to determine when to use your state mandated
law (fully insured plans).
What is my out-of-pocket? This could help to
increase your benefit coverage to 100%.
Is there any Exclusion to the service codes or
service? If any, this is a good time to use your state
mandated law.
22
23. HOW DO I COMMUNICATE WITH MY
INSURANCE CARRIER?
May I have a reference number for this
call?
IMPORTANT **** WHAT IS THE BENEFIT
CUSTOMER SERVICE NAME? WHAT IS THE
REFERENCE NUMBER FOR THE CALL?
You may get different answers from your
providers verification. Always contact your
provider to compare answers.
23
24. INSURANCE WORDS
Medical Foods and Enteral Formula: Are the
same description with different words.
Service Codes: A description of service in a
numerical/alphabetical format.
Pre-certification also know as prior authorization:
An approval from your insurance company that
service are medically necessary and covered (i.e.
#1234567).
Deductible: An amount of money that needs to be
met before your insurance pays.
24
25. INSURANCE WORDS
Fully Insured Plan: When you may your own
premium or a percentage from your employer.
Self-funded Plan: When your employer pays for
your benefits or if you have Medicaid/Medicare
(state/federal funded plan).
Out-of-Pocket: Sometimes confused with
deductible. It’s when you pay for medical expenses
until you reach your insurance dollar amount. It
increases your co-insurance to 100% (if any). Does
not have to be met before insurance pays their part.
25
26. INSURANCE WORDS
Exclusions: Items or conditions that are not
covered by the general insurance contract.
Allowed Amount: Maximum amount on which
payment is based for covered health care services.
This may be called “eligible expense,” “payment
allowance" or "negotiated rate." If your provider
charges more than the allowed amount, you may
have to pay the difference.
Lets talk a little more about allowed amount……
26
27. MORE ON ALLOWED AMOUNT WITH HEALTH
INSURANCE PLANS…..
Example of an allowed amount: All of us with
health insurance think that 100% is covered in full,
or even 80%, 70%, 60%, 50% we think they pay the
full percentages. Right??
The answer is “NOT Typically”, this is how it works
with out us knowing. Example: The Allowable
Charge is typically a discounted rate rather than
the actual charge and considered payment in full
from your insurance company and the provider.
27
28. MORE ON ALLOWED AMOUNT WITH HEALTH
INSURANCE PLANS…..
It may be helpful to consider an example: You have
just purchased your medical food. The total charge for
the medical food comes to $100. If the provider is a
member of your health insurance company's network of
providers (in-network), they may be required to accept
$80 as payment in full for the medical food - this is the
Allowable Charge.
In-network providers: Your health insurance company
will pay all or a portion of the remaining $80, minus any
co-payment or deductible that you may owe. The
remaining $20 is considered provider write-off. You
cannot be billed for this provider write-off.
28
29. MORE ON ALLOWED AMOUNT WITH HEALTH
INSURANCE PLANS…..
Out of network providers: If, however, the
provider you purchased your medical foods from is
not a network provider then you may be held
responsible for everything that your health
insurance company will not pay, up to the full
charge of $100. This is your responsibility!
You can check the charges, allowed amount and
your patient responsibility from your EOB
(Explanation of Benefits). A statement, “not a bill”
provided by your insurance company. Or you can
ask for a copy from your provider.
29
30. HOW TO READ AN EXPANATION OF
BENEFITS (EOB)?
30
32. THIS BRINGS US TO OUR NEXT STEP MEDICAL
EXCLUSION REMOVALS AND
THE DIFFERENCE BETWEEN MEDICAL VS.
PHARMACY BENEFITS……
32
33. MEDICAL FOOD EXCLUSION REMOVALS FROM
EMPLOYERS
My insurance is not covering my formula because
there is an exclusion. How do I get my exclusion
removed?
Answer: Usually your exclusions come from your
employers contracted plan with your insurance
company. You will have to present a letter of
medical necessity (LOMN) and a medical food
exclusion removal request letter to your Human
Resource Department for assistance.
For Federal and State plans, exclusion removals
are a bit complex. You should seek assistance from
a certified insurance advocate. 33
34. MEDICAL FOOD EXCLUSION REMOVALS TOOLS
LOOKING FOR HELP AND TOOLS???
Please find template letters for medical food exclusion
removal request letters and letter of medical necessities on
the NPKUA website.
http://www.npkua.org/Resources/InsuranceCoverage.asp
x.
34
35. DIFFERENCE BETWEEN MEDICAL BENEFIT
VS. PHARMACY BENEFIT
Medical benefits for Enteral Formula/Medical Foods
use a HCPCS code (i.e. B4157, S9435). Pharmacy
benefits uses NDC codes to identify a particular
“product” not a medical service such as a HCPCS
code.
Depending on the patient’s insurance plan, some
may have enteral formula/medical foods covered
only under medical, some only under pharmacy or
both. Some pharmacies bill both DME & Pharmacy
covered items. Some just cover pharmacy benefits.
Nothing here ostracizes a medical benefit or
pharmacy benefit.
35
36. DIFFERENCE BETWEEN MEDICAL BENEFIT
VS. PHARMACY BENEFIT
It’s important to understand the difference. It can be
a bit confusing to patients and some clinical
professionals.
This is one of the reasons why it is good to verify
both benefits to choose the most affordable benefit
choice!
36
37. INSURANCE ADVOCATE SUPPORT
For certified insurance advocate support:
Compassion*Works Medical and the NPKUA
INSURANCE COACHES PROGRAM.
The NPKUA has a new resource to help guide you
through the difficult process of obtaining medical
foods coverage. The NPKUA Insurance Coaches
Program, led by Raenette Franco, CEO, CBCS of
Compassion*Works, is a place that can help!
37
39. DO YOU HAVE MEDICAID OR MEDICARE?
HERE ARE SOME TIPS!
My Medicaid and/or Medicare plan does not cover
my formula?
Answer: First do you have a straight plan from the
state? If so, the best way to get covered under your
plans would be to enroll into a Managed Medicaid
or Medicare plan. A supplement plan is not the
same as a managed plan. Supplement plans follow
the same rules with the straight plans.
39
40. WHAT IS A MANAGED MEDICAID/MEDICARE
PLAN?
The term managed care or managed health care is
used in the United States to describe a variety of
techniques intended to reduce the cost of providing
health benefits and improve the quality of care.
A managed Medicaid or Medicare plan is the middle
man between your straight care plan and the managed
care plan (i.e. Aetna, Humana, United Health Care, Blue
Cross Blue Shield, etc.).
It offers special needs and leniency towards medical
food coverage than a straight state plan.
Most state Medicaid plans pushes to a managed care
plan. Medicare is your choice. However, best choice! 40
41. HOW DO I FIND A MANAGED CARE PLAN FOR
MY STATE?
Managed Medicare plans; use Medicare Plan
Finder at https://www.medicare.gov/find-a-
plan/questions/home.aspx. Or simply call member
services listed on the back of your Medicare card.
Managed Medicaid plans; call member services
listed on the back of your Medicaid card.
41
42. HOW TO GET HELP….
42
Simple Steps of how to get help provided by Compassion Works
Medical . Trained and managing the NPKUA volunteer insurance
coaching program.
1. For one on one coverage support and more coverage
information, please contact the NPKUA Reimbursement
Coaches. Call NPKUA to see if there is a Coach in your state.
2. Please visit the NPKUA website http://www.npkua.org
3. Contact Compassion*Works Medical, LLC at
(973) 832-4736 or email: support@compassionworksmrs.com
We want to help you get there!
43. HOLDING HANDS FOR PATIENT ADVOCACY SUPPORT
Compassion*Works Medical mission is to provide
Medical Food Coverage/Reimbursement and true patient
advocacy support to clinics and people with rare
genetic diseases.
We are the first responders for coverage support!
Together with we can go a long……way!
You are not alone. We are here to hold your hand all the
way through the difficult tasks of medical food
coverage!
Contact: Raenette Franco, CEO, CBCS
raenettef@compassionworksmrs.com
43
We will talk about a few things regarding coverage assistance.
A lot of people can get confused between deductible and out of pocket.
Basically proving that the medical food/enteral formula is medically necessary and appropriate.
1. Member purchases medical food from provider, 2. Member acknowledges the charges, 3. Provider submits claim to insurance company, 4. Insurance company process claim w/allowed amount 5. insurance company sends and EOB to member and provider, 6. Payment is sent to provider 7. A final statement from the insurance financial department will send to member and provider.
How many of you know the difference between a medical food medical benefit and medical food pharmacy benefit? It can be a bit confusing which benefits covers medical foods.