Is PMI the new CIC? And are there too many TLAs in our world? Thought-provoking insights from Cameron Roberts and experts about the demise of our public health sector and relationship with PMI demand. There's no overnight fix to the state and performance of the NHS, and if it ever recovers, there's the important matter of choice that PMI offers. I agree with Kyle Godden that we may (and should) end up with a three tier system, there is certainly room and need for lower-cost, more targeted PMI solutions (focusing on diagnostics and core benefits). But this also highlights the importance of advice for PMI too - with so many choices and the beartaps of moratoriums - there's a strong case for an advised broker model vs direct insurer. Consumer Duty anyone? LifeSearchAlan Richardson Dip CII Christopher Paul Mooney Poonam Khan Alastair Smart Paula Bertram-Lax Ricky Butler Debbie Kennedy Rose Howarth #healthmatters #protectingpeopleproperly #refreshingprotection #privatehealth
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Why is healthcare stuck in a trust crisis? We all want change in healthcare. Better care, lower costs, and equal access. But here's the problem… Who do people really trust in healthcare? And… can that trust actually lead to the change we need? Let's break it down. According to a survey by the American Board of Internal Medicine (ABIM): 85% of people trust nurses 84% trust doctors 72% trust hospitals Only 56% trust pharma companies And a shocking 33% trust insurance companies Hold on, it gets more interesting when we ask doctors. Doctors were asked if they trusted hospital executives. Any guesses? Only 53% do. 17% of doctors trust pharma companies — wow. And just 19% trust insurance companies. Yes, doctors trust insurance companies even less than patients do! So, if trust is this low… How can we expect insurance companies to drive patient behavior? Or hospital executives to change the way doctors practice? Here’s the takeaway: To bring real change in healthcare, we need trust. But it can’t come from where trust doesn’t exist. Let’s rethink how we create change in this system. P.S. Who do you trust most in healthcare today? #HealthcareReform #TrustInHealthcare #PatientCare #DoctorPatientRelationship #HealthcareInnovation
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🩸🆎️🅰️🅾️🅱️💉 Non-compliance with Patient Blood Management (PBM) guidelines can have significant consequences for healthcare organizations. Here's a breakdown of how disregarding PBM guidelines can impact healthcare facilities: ➡️ Increased Costs: Ignoring PBM protocols may lead to unnecessary blood transfusions, driving up expenses related to purchasing and administering blood products. ➡️ Reimbursement Issues: Failure to adhere to PBM practices can result in denied claims or reduced reimbursement rates from payers, posing financial risks. ➡️ Legal Consequences: Violating patient care regulations, particularly those concerning blood management, may expose healthcare providers to legal liabilities such as fines or lawsuits. ➡️ Reputation Damage: Non-compliance with patient care standards outlined in PBM guidelines can tarnish a healthcare organization's reputation, potentially resulting in missed business opportunities. Providers who fail to comply are susceptible to audits for Fraud, Waste, and Abuse (FWA). These audits focus on ensuring adherence to CMS and health insurance medical policy guidelines by identifying potential FWA activities. Collaboration among all stakeholders is crucial for implementing effective strategies, ensuring policy compliance, and monitoring regularly to enhance clinical outcomes, resource utilization, and financial sustainability. Credits to Mariela Noriega, MT(ASCP), JD , and Nicole De Vita for such an amazing work towards the quality of healthcare. #Healthcare #PatientCare #Compliance #PBM #HealthcareManagement #HealthcareIndustry #FinancialStability
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Humana Inc. has filed a lawsuit against U.S. health agencies over Medicare quality rating cuts that could cost the company billions in lost revenue. The outcome of this case may not only affect Humana’s financial future but also influence the broader health insurance industry. Find out how this legal battle could reshape Medicare Advantage plans. https://wix.to/w9TZIPq #newblogpost, #Humana #MedicareAdvantage #HealthcareLawsuit #HealthInsurance #StarRatings #Medicare #HumanaLawsuit #InsuranceIndustry #HealthPolicy #MedicareProviders
Humana Sues U.S. Health Agencies: Potential Billions at Stake
justinouimet.com
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🚧 The road to fair reimbursement is still bumpy for healthcare providers. A recent report reveals that more than one-fifth of insurers failed to pay No Surprises awards last year. Stay informed, stay ahead. Read it here: 🔗 https://lnkd.in/eJhvT8Ea Follow us for more updates that help navigate the complex landscape of the personal injury business. #personalinjurymadeeasy #nosurprisesact #californiadoctors
More than one-fifth of insurers failed to pay No Surprises awards last year, provider lobby says
healthcaredive.com
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Hospital grading provides trusted opinions and authentic records, helping patients make informed choices. It ensures high-quality care selection, enhances operational benchmarking, and aids in effective government grant allocation. Additionally, it supports career evaluation for healthcare professionals, efficient insurance structuring, and highlights management expertise. #HospitalGrading #HealthcareQuality #PatientSafety #InformedChoices #HealthcareBenchmarking #GovernmentGrants #HealthcareCareers #InsuranceRates #HealthcareManagement
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Patient Financial Advocacy aims to assist individuals in navigating the complexities of healthcare costs. Advocates educate patients on insurance coverage, billing procedures, and available financial assistance programs. They negotiate with providers, ensuring fair and transparent pricing. Advocates also help identify potential errors in medical bills and work towards their resolution. By providing crucial financial information, they empower patients to make informed decisions about their healthcare. Overall, Patient Financial Advocacy plays a vital role in alleviating financial stress and ensuring equitable access to quality healthcare. Key Points: ✔Guides patients through healthcare cost complexities. ✔Educates on insurance coverage and billing procedures. ✔Negotiates fair pricing with healthcare providers. ✔Identifies and resolves potential billing errors. ✔Empowers patients to make informed financial decisions. Visit us to know more: https://lnkd.in/dR2C4cMJ For Service call: + 1 864 650 6400 or, info@qualify.health #health #publichealth #qualify #copay #healthinsurance #insurance #deductible #financialadvocacy #healthcare #medicare #health #coinsurance #doctorvisit #insuranceclaim #medicalinsurance #medicalbilling #healthbenefits #baddebt #financialsupport #supportServices #CancerSupport #healthEquity #cancercosts #patientadvocacy #copayassistance #patientassistanceprograms
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💊 Did you know? More health insurance plans are now covering prescriptions written by pharmacists as states expand their authority. Get faster, more affordable care without needing a doctor visit. 🏥 #HealthcareAccess #PharmacistPrescriptions #TestToTreat Check out the latest update on pharmacist prescribing laws! 💬 According to the American Pharmacists Association, this change could lead to improved healthcare outcomes, especially in underserved communities. #HealthcareInnovation #PatientCare https://lnkd.in/eYCf6R7A
Insurers Expand Coverage of Pharmacist-Prescribed Medications
aromedy.com
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DentaQuest's Dave Olson explains how Medicare Advantage can fill gaps in serving seniors' health needs in this Healthcare Business Review article. #MedicareAdvantage #Medicare #healthcare #oralhealth #seniorhealth
How can Medicare Advantage better serve seniors?
post.dsmn8.com
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✔Definition: Prior Authorization (PA) is a process used by insurance companies to determine if they will cover certain medications, treatments, or procedures prescribed by a healthcare provider. ✔Purpose: It helps control costs and ensure that treatments are medically necessary. Process: ✔Provider submits request: The healthcare provider sends detailed information about the treatment to the insurance company. ✔Review by Insurer: The insurer evaluates the request based on medical guidelines and policy criteria. ✔Approval or Denial: The insurer either approves or denies the request. If denied, an explanation is provided. ✔Appeals: Patients have the right to appeal a denied authorization. ✔Timelines: Prior authorizations can take from a few hours to several days. ✔Importance: It balances cost control with patient access to necessary care. ✔Challenges: Delays in approvals can hinder timely treatment. ✔Patient Advocacy: Patients should be aware of their rights and communicate effectively with their healthcare team. ✔Future Trends: Streamlining PA processes through technology is being explored for efficiency. Visit us to know more: https://lnkd.in/dR2C4cMJ For Service call: + 1 864 650 6400 or, info@qualify.health #health #publichealth #qualify #copay #healthinsurance #insurance #deductible #financialadvocacy #healthcare #medicare #health #coinsurance #doctorvisit #insuranceclaim #medicalinsurance #medicalbilling #healthbenefits #baddebt #financialsupport #supportServices #CancerSupport #healthEquity #cancercosts #patientadvocacy #copayassistance #patientassistanceprograms
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Healthcare insurance claims mistakes drive up healthcare costs: in 2023, CMS.gov reported 7.38% improper payment rate in the Medicare FFS program, totaling $31.23 billion. In our latest article on the role of data validation in healthcare, we share details on how proper data handling ensures seamless patient care and reduces costs. Explore best approaches and real-world examples to find practical solutions for overcoming data validation challenges: https://lnkd.in/dDwjDsEp
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Driving Good outcomes for customers and our business.
6moThe NHS has always been under pressure. Not since the late days of labour (things can only get better) has the NHS been able to meet its own targets. What appears to be significantly different now is the care provided post op. Beds that would normally have been freed up are now taken as too many poor individuals have not the access to the care needed. So, until an innovative insurer comes up with a thoroughly thought out private care policy, funding treatment by insurance is an essential remedy. Buying CIC to cover the cost off private health care has never really sat right with me. For me, CIC is there to cover the additional costs of being ill. Comparatively, the cost of cancer insurance on PMI is lower than CIC in most circumstances. PMI importantly is going to get you diagnosed quicker. So, is PMI the new CIC? No. The policies do different things. I remember a conference a few years back where individuals passionately argued that protection advisers shouldnt sell PMI, and vice versa. Balderdash I say! Customers do not have limitless budgets. Only by having joined up conversations can a true Risk Management programme be arranged that addresses the priorities of the customer.