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After losing to Aetna, Blue Cross Blue Shield NC is calling it quits on its legal fight to retain the contract to administer the state’s health plan. State workers: Your benefits will soon go ...
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Aetna Inc. (/ ˈ ɛ t n ə / ET-nə) is an American managed health care company that sells traditional and consumer directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid (fully or partly) insurance and benefit programs, and through Medicare.
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Calad was a Supreme Court of the United States appeal and ruling, where CIGNA Healthcare, Inc. challenged a United States Court of Appeals for the Fifth Circuit ruling in favor of Mrs. Ruby Calad, who was insured under her husband's employer's self-funded medical insurance plan in the State of Texas. This was a Landmark Supreme Court Case.
In some jurisdictions, a petition for review is a formal request for an appellate tribunal to review the decision of a lower court or administrative body. [1] If a jurisdiction utilizes petitions for review, then parties seeking appellate review of their case may submit a formal petition for review to an appropriate court. [ 2 ]
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 ...
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