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Health Plan Policyholders [in Wisconsin] Can Appeal Claims Denials to a Third Party
EXCERPT: "Two situations qualify a claim for an appeal. First, when a policyholder's claim is denied, or partially denied, because the health plan determined treatment wasn't medically necessary. Second, when the claim is denied because the treatment was determined to be experimental."
Full Article...
Additional information is also available:
Fact Sheet on the Independent Review Process in Wisconsin
4/3/02—State of Wisconsin Office of the Commissioner of Insurance
U.S. Companies to Give Workers More Responsibility for Health Care Benefits
EXCERPT: "U.S. workers can expect to take on more responsibility for their own health care needs and costs as companies re-evaluate how they manage and administer their benefits programs, according to a survey of large employers conducted jointly by Watson Wyatt and the Washington Business Group on Health."
Full
Article...
5/15/02—Watson Wyatt Worldwide
Few Plans Shedding 'Tiers'
EXCERPT: "Blue Cross of California is the first health insurance company to drop plans to charge consumers extra for going to select, costlier hospitals. But don't expect other health plans to follow suit."
Full
Article...
5/31/02—East Bay Business Times via BizJournals.com (free registration required)
Medical Errors, Unnecessary Treatments, Misused Drugs Cost U.S. Employers $390B
per Year, Study Says
EXCERPT: "The report found that the 'vast majority' of American companies focus too heavily on the price of employee health care and not enough on the quality of health plans (Freudenheim,
New York Times, 6/11). The study also determined that a 'broad set of standard measurements or ratings
systems' for employees to evaluate health plans does not exist (Japsen, Chicago
Tribune, 6/11)." Full
Article...
6/11/02—kaisernetwork.org
Consumer Reports Examines Cost-Shifting Trend in Employer-Based Health
Insurance
EXCERPT: "The current issue of Consumer Reports 'explains the new cost
burdens' for workers with employer-sponsored health insurance and offers advice on how to select an appropriate health plan. The article outlines three emerging strategies employers are using to lower their health-related costs."
Full
Article...
6/11/02—kaisernetwork.org
Web Site Worth A Closer Look
EXCERPT: "You may be interested in the material on this site if you participate in or sponsor any project to educate consumers about health care quality or inform them about the performance of specific health care organizations. Whether your organization is public or private, for-profit or nonprofit, large or small, local or National, you share a common challenge with other project sponsors: How can you convey comparative information about health care quality so that consumers can both understand and use the data to make better-informed decisions?"
www.TalkingQuality.gov
Sponsored by the Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare & Medicaid Services, and the Office of Personnel Management.
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Knowledge
is Power
The U.S. Department of Health and Human Services
publishes a list of select toll-free numbers for organizations that provide health-related information, education, and support. These organizations do NOT diagnose or recommend treatment for any disease. Some of the organizations use recorded messages; others provide personalized counseling and referrals. Most offer educational materials; some charge handling fees.
How can your
organization use this information? How about ordering materials to supplement a specific in-house wellness program topic, or distribute the entire list to your employees as part of a general wellness effort.
A sample of topics covered in this list includes:
Adoption
Aging
AIDS/HIV
Alcohol Abuse
Allergy/Asthma
Alzheimer's Disease
Arthritis
Audiovisuals
Autism
Autoimmune Diseases
Bone Marrow
Bone Disease
Brain Tumors
Cancer
Cerebral Palsy
Chemical Products/Pesticides
Child Abuse/Missing Children/Mental Health
Child Development/Parenting
Crisis Intervention
Cystic Fibrosis
Diabetes/Digestive Diseases
Disabling Conditions/Disabilities Access
etc...
The complete list is available via the Internet in html or pdf format at
www.health.gov/NHIC/Pubs/. To order printed copies of this publication or to obtain this publication on disk (PDF, html, RTF), contact the ODPHP Communication Support Center, P.O. Box 37366, Washington, DC 20013-7366; fax (301) 468-7394.
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The preceding is not
intended to be and is not offered as legal advice. We are prohibited
from the practice of law. Compliance is the responsibility of the
employer or Plan sponsor and affected employees, who should seek their
own legal counsel regarding questions about information presented in
this newsletter.
PlanAhead Direct is a
monthly newsletter provided free of charge to select BSG® client
representatives and associates. View and search back issues at www.bsg.com/news/index.htm.
To comment on newsletter
content, write to tessr@bsg.com.
If you would like to change
your subscription address, or request a plain text
version, please e-mail your request to carolz@bsg.com.
Copyright 2002 The Benefit Services
Group, Inc. BSG® is a registered trademark of The Benefit Services
Group, Inc.
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tel 262-521-5700
fax 262-521-5710
www.bsg.com
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