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Client/Member Aggravation
An employee was having difficulty receiving approval for medication. They were being supplied samples of medication by their provider, but the provider advised that they were running out of samples.
BenefitsVIP Intervention
I called the employee’s provider and spoke with the nurse handling their case, and was advised that they tried to appeal the denial back in April 2007, but were still unsuccessful obtaining approval. I asked the nurse to send me all documentation to date, and I would intervene and work with the insurance carrier.
Resolution
I received all documentation from the nurse, and after reviewing the documentation I noticed additional documentation from the provider was required. I contacted the nurse and asked her to supply me with a new prior authorization form and the additional documentation, which I immediately received. I sent this information over to the insurance carrier for a priority review, and received a response the same day advising approval was granted indefinitely. |
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Handwashing
Rubbing your hands together with soap and water reduces the spread of germs from one person to the next. According to the US Centers for Disease Control and Prevention, hand washing is one of the most important means of preventing the spread of infection. A recent survey found that 94% of Americans say that they always wash their hands after using the bathroom. Observations in public restrooms show that only 68% of adults did so. Germs can cause illnesses like diarrhea and colds as well as more serious, and life-threatening, diseases. |
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How To Prevent High Cholesterol
Eating a diet low in saturated fat and cholesterol, getting plenty of exercise, managing your weight, and not smoking can help prevent high cholesterol. Because cholesterol levels tend to increase with age, paying attention to diet and exercise is particularly important as you get older. Remember that high cholesterol is just one of the things that increase your risk for coronary artery disease (CAD) and heart attack. |
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Does HIPAA Guarantee Privacy for My Medical Information?
No. This is a major misconception about privacy in general. There is no universal privacy rule, even for sensitive medical information. Any privacy you do have depends on a number of things, primarily who has your information. HIPAA provides some limited privacy protections. But, HIPAA only applies to “covered entities,” that is health care providers, health plans, and what HIPAA calls “health care clearing houses,” or those who transmit payment information electronically. |
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| Using your healthcare benefits wisely is important to ensure a long, healthy life. When it comes to medical fees a new study finds $12 may not seem like much, but it has been enough to deter many women from getting a mammogram to detect breast cancer. Yes, that’s correct...a $12 copay may save your life!
Screening rates from 2001-2004 were nearly 11% lower for women who had to contribute a copay as low as $12, compared to women whose mammograms were free.
Studies have suggested that mammograms may save lives by detecting breast cancers at an earlier, more curable, stage. This is a case where copayments adversely affected health. It would make clinical sense, and probably economic sense, for a health plans to eliminate a copay for a mammogram.
The researchers’ surveyed more than 366,000 women aged 65-69 and found that mammography rates were about 4% lower for women living in areas where the people were poor or poorly educated, if they were required to pay part of the cost. In 2001, only one woman in 200 was required to make a copay for a mammogram. By 2004 the ratio was 1 in 9.
The findings suggest that the introduction of a small out-of-pocket expense led 8% of consumers to opt out of mammography, a decision that on average was not in the best interest of their overall health.
Alarming Fact: Breast cancer was diagnosed in 178,000 U.S. women in 2007, and killed more than 40,000. |
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Last Chance to Book Your Flu Shot!
An important message from the Phila. Depart. of Health
Staying healthy during the flu season not only impacts you but your co-workers as well. Flu shots reduce your risk of influenza and manages the spread to others. Taking pro-active measures is the key to maintaining a healthy workplace.
Flu season is in full swing since the start of 2008, with wide outbreaks in 11 states according to the government’s public health chief. A new strain is starting to emerge that this year's vaccine doesn't specifically target.
The CDC advises that people should still get their flu shot (an influenza vaccination offers 70 to 90% protection against infection). Flu shots are recommended for adults 50 and older, children 6 months to 5 years.
The nasal-spray version of the vaccine (approved for ages 5 to 49) seems to offer even broader protection against tough-to-predict viruses that appear later in flu season. Children are at particular risk |
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