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Help is at Hand
by Elizabeth Hagan
Accident, Sickness and Health Insurance for NC Pre-Licensing Candidates, 3rd Edition
by Ron C. Robinson
The Wages of Sickness
by Beatrix Hoffman
Hoffman examines each of the major combatants in the battle over compulsory health insurance. While physicians, employers, the insurance industry, and conservative politicians forged a uniquely powerful coalition in opposition to health insurance proposals, she shows, reformers’ potential allies within women’s organizations and the labor movement were bitterly divided. Against the backdrop of World War I and the Red Scare, opponents of reform denounced government-sponsored health insurance as “un-American” and, in the process, helped fashion a political culture that resists proposals for universal health care and a comprehensive welfare state even today.
This report provides the first-ever comparative analysis of the role and performance of private health insurance (PHI) in OECD countries. It analyses PHI markets and identifies policy issues arising from their interdependence with publicly financed health coverage schemes. The report assesses the impact of PHI against health policy objectives, paying special attention to the challenges and benefits associated with different insurance mixes. The analysis identifies strengths as well as areas where private health insurance might pose challenges to health system performance. This report shows how governments can help ensure that PHI markets make a positive contribution to the performance of health systems. Examples of useful practices for developing more efficient and equitable health insurance markets are also presented.
Social Health Insurance Systems In Western Europe
by Saltman, Richard, Rico, Ana, Boerma, Wienke
Life and Health Insurance License Exam Cram
by BISYS Educational Services
If you are studying for your life and health insurance licensing exam, we have the ultimate study tool for you. Life and Health Insurance License Exam Cram is a great resource to help you learn the concepts, laws, rate calculations and state and federal regulations that will be covered on the exam. You’ll also receive a CD that includes a fully-customizable test engine, detailed score report and state-specific law supplement. No matter where you are taking your exam or which area you need to focus on during your studying, Life and Health Insurance License Exam Cram is your smartest way to get certified.
Please note: The CD-ROM and test engine is NOT Mac iOS compatible.
Medicaid and CHIP (Children’s Health Insurance Program): Reports for Monitoring Children’s Health Care Services Need Improvement
Medical Insurance Made Easy – E-Book
by Jill Brown
- 3 separate chapters offer coverage of the basic concepts of medical coding.
- A comprehensive overview of the CMS-1500 claim form with step-by-step guidelines and illustrations thoroughly covers reimbursement issues and explains the billing process.
- Includes detailed information on various insurance payers and plans including Medicare, government medical plans, disability plans, private indemnity plans, and managed care.
- Stop & Review sections illustrate how the concepts presented in each chapter relate to real-life billing situations.
- Sidebars and Examples highlight key concepts and information related to the core text lesson.
- A companion CD-ROM contains sample patient and insurance information that readers can use to practice completing the accompanying CMS-1500 claim form, as well as a demonstration of Altapoint practice management software.
- Features completely updated information that reflects the many changes in the insurance industry.
- Contains a new chapter on UB-92 insurance billing for hospitals and outpatient facilities.
- Includes a new appendix, Quick Guide to HIPAA for the Physician’s Office, to provide a basic overview of the important HIPAA-related information necessary on the job.
ERISA and Health Insurance Subrogation in all 50 States – 5th Edition
by Gary L. Wickert
ERISA and Health Insurance Subrogation In All 50 States
is the most complete and thorough treatise covering the complex
subject of ERISA and health insurance subrogation ever published.
NEW TO THE FIFTH EDITION!
• Updated To Include All The Newest Case Law!
• Updated To Include Medicaid Subrogation and Preemption of FEHBA !
• New Plan Language Recommendations!
• Complete Health Insurance Subrogation Laws In All 50 States
• Covers The Application of ERISA In Every Federal Circuit
The Fifth Edition of ERISA and Health Insurance Subrogation In All 50 States
has been completely revised, edited, and reorganized. This was partly
to reflect the new direction recent case decisions have taken
regarding health insurance subrogation as well as the crystallization of
formerly uncertain and nebulous areas of the law which have now
received some clarity. An entirely new chapter entitled, “What
Constitutes Other Appropriate Equitable Relief?” has been added and
replaces the old Chapter 9, which merely dealt with Knudson and
Sereboff. The new edition introduces new state court decisions
addressing the issue of causation and whether and when a subrogated Plan
seeking reimbursement must prove that the medical benefits it seeks to
recover were causally related to the original negligence of the
tortfeasor. An entirely new section was added concerning the subrogation
and reimbursement rights of Medicare Advantage Plans, a
statutorily-authorized Plan which provides the same benefits an
individual is entitled to recover under Medicare. This includes recent
case law which detrimentally affects the rights of such Plans to
subrogate. Also added to the new edition is additional law and
explanation regarding Medicaid subrogation, including the
differentiation between “cost avoidance” and “pay and chase” when it
comes to procedures for paying Medicaid claims. Significant improvements
have been made to suggested Plan language which maximizes a Plan’s
subrogation and reimbursement rights. The suggested language stems from
recent decisions and developments in ERISA and health insurance
subrogation from around the country since the last edition.
The new edition has been completely reworked both in substance and
organization. Recent case law has necessitated consolidation of several
portions of the book and elimination or editing of others. A new section
entitled “Liability of Plaintiff’s Counsel” has been added, which
provides a clearer exposition on the laws applicable and remedies
available when plaintiff’s attorneys and Plan beneficiaries settle their
third-party cases and fail to reimburse the Plan. Also new to the book
are recently-passed anti-subrogation measures such as Louisiana’s Senate
Bill 169, § 1881, which states that no health insurer shall seek
reimbursement from automobile Med Pay coverage without first obtaining
the written consent of the insured.
The new edition also goes into much greater detail on the procedures for
and law underlying the practice of removal of cases from state court to
federal court, and the possibility of remand back to state court. This
includes the Federal Courts Jurisdiction and Venue Clarification Act of
2011, effective Jan. 6, 2012, which amended federal removal, venue, and
citizenship determination statutes in very significant ways. The new
edition also delves into, for the first time, the role which the federal
Anti-Injunction Act plays when beneficiaries sue in state court to
enforce the terms of an ERISA Plan, while the Plan files suit in federal
court seeking an injunction against the state court action. New case
law and discussion on preemption of FEHBA subrogation and reimbursement
claims have been added to Chapter 10 in the wake of new decisions
Health Insurance Resources
by Kimberly Calder, MPS, Stephen E. Cooper, Dorothy E. Northrop, MSW, ACSW
The manual is completely updated throughout, and reflects the changes in the system since the first edition’s publication in 2003. Crucially, the book includes new information about the new Medicare Prescription Drug Coverage plan, which took effect in January 2006. It also covers:
- Social Security Disability Insurance and Supplemental Security Income
- State High Risk, Pools
- Insurance glossary
- State pharmacy assistance programs
- And much, much more!
This essential guide contains information about a wide variety of options that will be of assistance to individuals who are uninsured, underinsured, or who have questions about insurance and don’t know where to begin. It will also serve those who work with chronically ill individuals and their families, such as health care professionals and para-professionals, consumer and patient advocates, and the educators and institutions that serve them.
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