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The member(s) are not required to use a gatekeeper or obtain a referral before seeing a specialist. In that case, the traditional benefits are applicable. If the member uses a gatekeeper, the HMO benefits are applied. However, the beneficiary cost sharing (e.g., co-payment or coinsurance) may be higher for specialist care. [3]
While Concentra is currently the product of a number of mergers, the original company was OccuSystems Inc., founded in Amarillo, Texas by Dr. Richard Rhem in 1979. [2] After completing his residency and moving to Buffalo, Wyoming to practice family medicine for three years, he opened a practice in the underserved Amarillo, which he thought presented an opportunity. [2]
Humana pulled out of the acquisition after United stock dropped $2.9 billion in value. [9] In 2001, Humana was a cofounder of Avality. [10] In 2005, Humana entered into a business partnership with Virgin Group, offering financial incentives to members for healthy behavior, such as regular exercise. [11]
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Medigap Plan G is a Medicare Supplement Insurance plan to help pay expenses from Medicare Part A and Part B. It is also called Medicare Plan G. A person is eligible to enroll during the Open ...
For this measure, plans are allowed to select a random sample of the population and supplement claims data with data from medical records. By doing so, plans may identify additional immunizations and report more favorable and accurate rates.
Stark Law is a set of United States federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient to an entity for the provision of designated health services ("DHS") if the physician (or an immediate family member) has a financial relationship with that entity.
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