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Short-term health insurance plans are exempt from most insurance regulations established by the Affordable Care Act, are not required to cover the full list of health benefits required by that legislation, and may offer lower premiums to individuals who enroll prior to developing pre-existing conditions. [4]
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
Home health is a nursing specialty in which nurses provide multidimensional [1] home care to patients of all ages. Home health care is a cost efficient way to deliver quality care in the convenience of the client's home. [2] Home health nurses create care plans to achieve goals based on the client's diagnosis.
There are a number of reasons that insurance providers require prior authorization, including age, medical necessity, the availability of a generic alternative, or checking for drug interactions. [ 2 ] [ 3 ] A failed authorization can result in a requested service being denied or in an insurance company requiring the patient to go through a ...
You misrepresented yourself on your application: For instance, if you omitted that you own a restricted dog breed or that you do not plan on living in the home full-time, your insurance company ...
Medical underwriting is a health insurance term referring to the use of medical or health information in the evaluation of an applicant for coverage, typically for life or health insurance. As part of the underwriting process, an individual's health information may be used in making two decisions: whether to offer or deny coverage and what ...
In-home medical care is often and more accurately referred to as home health care or formal care. Home health care is different non-medical care, custodial care, or private-duty care which refers to assistance and services provided by persons who are not nurses, doctors, or other licensed medical personnel. For patients recovering from surgery ...
The same committee analyzed the effects of health insurance on adult's health outcomes: adults who do not have health insurance coverage who acquire Medicare coverage at age 65, experience substantially improved health and functional status, particularly those who have cardiovascular disease or diabetes.