scholarly journals Third-Party Payers…. The Silver Bullet?

2019 ◽  
Vol 40 (03) ◽  
pp. 207-213
Author(s):  
Amit Gosalia
Keyword(s):  
Healthcare Reform ◽  
Hearing Aid ◽  
Third Party ◽  
Insurance Companies ◽  
Healthcare Industry ◽  
Delivery Model ◽  
Health Insurance Companies ◽  
Middle Man ◽  
Silver Bullet ◽  
Third Party Payers

AbstractHealthcare reform brought about many changes in the healthcare industry including the hearing aid delivery model. Third-party payers (TPPs) became a growing trend with health insurance companies. The traditional hearing aid delivery model changed from provider and patient to provider, TPP, and patient. Due to the insertion of this middle man, profit can be diminished from the hearing aid sale, along with processes. Based on this decrease in revenue, decisions need to be made if using a TPP is profitable or even affordable for a clinic. Recent polls indicate more than half of those clinics polled currently do not participate with TPPs.

scholarly journals Which health-related reasons lead to prehospital emergency care and how does subjective emergency status connect to subsequent care?

2021 ◽  
Author(s):  
Silke Piedmont ◽  
Anna Katharina Reinhold ◽  
Jens-Oliver Bock ◽  
Enno Swart ◽  
Bernt-Peter Robra
Keyword(s):  
Health Insurance ◽  
Emergency Care ◽  
Third Party ◽  
Insurance Companies ◽  
Prehospital Emergency Care ◽  
Health Related ◽  
Life Threatening ◽  
Prehospital Emergency ◽  
Health Insurance Companies ◽  
Reported Data

Abstract Objectives/Background In many countries, the use of emergency medical services (EMS) increases steadily each year. At the same time, the percentage of life-threatening complaints decreases. To redesign the system, an assessment and consideration of the patients’ perspectives is helpful. Methods We conducted a paper-based survey of German EMS patients who had at least one case of prehospital emergency care in 2016. Four health insurance companies sent out the questionnaire to 1312 insured persons. We linked the self-reported data of 254 respondents to corresponding claims data provided by their health insurance companies. The analysis focuses a.) how strongly patients tend to call EMS for themselves and others given different health-related scenarios, b.) self-perceived health complaints in their own index case of prehospital emergency care and c.) subjective emergency status in combination with so-called “objective” characteristics of subsequent EMS and inpatient care. We report principal diagnoses of (1) respondents, (2) 57,240 EMS users who are not part of the survey and (3) all 20,063,689 inpatients in German hospitals. Diagnoses for group 1 and 2 only cover the inpatient stay that started on the day of the last EMS use in 2016. Results According to the survey, the threshold to call an ambulance is lower for someone else than for oneself. In 89% of all cases during their own EMS use, a third party called the ambulance. The most common, self-reported complaints were pain (38%), problems with heart and circulation (32%), and loss of consciousness (17%). The majority of respondents indicated that their EMS use was due to an emergency (89%). We could detect no or only weak associations between patients’ subjective urgency and different items for objective care. Conclusion Dispatchers can possibly optimize or reduce the disposition of EMS staff and vehicles if they spoke directly to the patients more often. Nonetheless, there is need for further research on how strongly the patients’ perceived urgency may affect the disposition, rapidness of the service and transport targets.

scholarly journals A Simple Model of Health Insurance Competition

2013 ◽  
Vol 14 (4) ◽  
pp. 432-448 ◽  
Author(s):  
Alexander Kemnitz
Keyword(s):  
Health Insurance ◽  
Simple Model ◽  
Healthcare Reform ◽  
Consumer Welfare ◽  
Insurance Companies ◽  
Contribution Rate ◽  
Health Insurance Companies ◽  
Two Alternatives

Abstract This study investigates competition between health insurance companies under different financing regulations. We consider two alternatives advanced in recent German healthcare reform discussions: competition by contribution rates (health contributions) and by fees (health premia). We find that contribution rate competition yields lower company profits and higher consumer welfare than premia competition when switching between insurance companies is costly.

scholarly journals Payer Coverage of Valley Fever Diagnostic Tests

2021 ◽  
Vol 23 (6) ◽  
pp. 155-161
Author(s):  
Chloe Grace Rose ◽  
◽  
Joshua , Kessler ◽  
Jennifer Weisbrod ◽  
Brittanie Hoang ◽  
...  
Keyword(s):  
Health Insurance ◽  
Third Party ◽  
Urgent Care ◽  
Insurance Companies ◽  
Specific Information ◽  
Prior Authorization ◽  
Valley Fever ◽  
Icd 10 ◽  
Health Insurance Companies ◽  
Impact Patient Care

Background The nonspecific symptoms of Valley fever, or coccidioidomycosis, hinders its proper diagnosis. This results in unnecessary health care costs and antibiotic usage. Thus, this study seeks to determine the coverage of the Valley fever diagnostic test as provided by Arizona insurance companies to increase early diagnosis rates. Methods Through scripted messaging and telephone communications, we contacted 40 health insurance companies in Arizona about their coverage of CPT 86635 (antibody diagnostic assay for Coccidioides) without prior authorization under all plan types provided in both primary and urgent care settings. If prior authorization was required, we discussed the coverage of ICD-10 codes J18.9 (pneumonia, unspecified organism), J18.1 (lobar pneumonia, unspecified organism), or L52 (erythema nodosum). Results Of the 40 health insurance companies contacted, 25 did not answer our inquiries, most requiring member-specific information to share coverage data. The remaining 15 companies covered Valley fever testing, of which 4 required prior authorization for the ICD-10 codes of interest. Of these 15 companies, 14 provided coverage in primary and urgent care settings, and 13 provided coverage for all available plans. Conclusion All payers that provided information covered Valley Fever testing. Most of the insurance companies that were unable to answer our inquiry likely cover Valley fever testing, but were unable to share information with third party inquiries. Obtaining general coverage information is difficult, which can potentially impact patient care.

Online Patient Consultation

2020 ◽  
Vol 158 (04) ◽  
pp. 345-350
Author(s):  
Christian Juhra ◽  
Jörg Ansorg ◽  
David Alexander Back ◽  
Dominik John ◽  
Andrea Kuckuck-Winkelmann ◽  
...  
Keyword(s):  
New Technologies ◽  
Communication Technologies ◽  
Phone Call ◽  
Insurance Companies ◽  
Personal Contact ◽  
Software Products ◽  
Patient Consent ◽  
Health Insurance Companies ◽  
Patient Consultation ◽  
Certified Software

AbstractNew communication technologies allow patients to communicate with their physicians from anywhere using computer or smartphone. Adding video to the mere phone call optimizes the personal contact between patient and physicians regardless of distance. Legal and reimbursements requirements must be taken into account, especially only certified software products must be used. In addition, patient consent is needed and confidentiality must be assured. The video patient consultation can be reimbursed by the health insurance companies. As with all new technologies, the introduction of these video consultations faced some challenges. Although patients and physicians have expressed great interest in this technology, it has been rarely used so far. The current COVID crisis increased the need for video consultations resulting in an increasing use of video patient consultation. It can be expected that this demand will still exists after the COVID crisis.

scholarly journals CioSy: A Collaborative Blockchain-Based Insurance System

Electronics ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1343
Author(s):  
Faiza Loukil ◽  
Khouloud Boukadi ◽  
Rasheed Hussain ◽  
Mourad Abed
Keyword(s):  
Data Storage ◽  
Insurance Industry ◽  
Emerging Technology ◽  
Third Party ◽  
Insurance Companies ◽  
Smart Contracts ◽  
Insurance Policy ◽  
Insurance System ◽  
Advanced Technologies ◽  
Multiple Challenges

The insurance industry is heavily dependent on several processes executed among multiple entities, such as insurer, insured, and third-party services. The increasingly competitive environment is pushing insurance companies to use advanced technologies to address multiple challenges, namely lack of trust, lack of transparency, and economic instability. To this end, blockchain is used as an emerging technology that enables transparent and secure data storage and transmission. In this paper, we propose CioSy, a collaborative blockchain-based insurance system for monitoring and processing the insurance transactions. To the best of our knowledge, the existing approaches do not consider collaborative insurance to achieve an automated, transparent, and tamper-proof solution. CioSy aims at automating the insurance policy processing, claim handling, and payment using smart contracts. For validation purposes, an experimental prototype is developed on Ethereum blockchain. Our experimental results show that the proposed approach is both feasible and economical in terms of time and cost.

Evaluation of Blockchain in Capital Market Use-Cases

2018 ◽  
Vol 10 (1) ◽  
pp. 54-76
Author(s):  
Sinsu Anna Mathew ◽  
Abdul Quadir Md
Keyword(s):  
Capital Markets ◽  
Capital Market ◽  
Use Cases ◽  
Third Party ◽  
Global Capital ◽  
Distributed Ledger ◽  
The World ◽  
High Integrity ◽  
Middle Man ◽  
Financial Transactions

This article describes the “Blockchain” which is an upcoming technology in the current leading world and which serves as a capital market use-cases for many of the global Fintech industries across the world, is a distributed ledger of economic transactions which not only used for recording financial transactions but mostly everything of value in this world. In the current world, mostly all the transactions are done through online which mainly includes the bank as a “middle man,” which could be untrustworthy at times. Blockchain comes into the picture which eliminates the need of a middle man or third party between the users who are involved in the transactions. Represents a financial ledger entry of data structure which consists of record of transactions which is digitally signed and cannot be tampered as authenticity is ensured in which the ledger is considered to be of high integrity. One of the leading and highly valued platform of blockchain is “Hyperledger Fabric” which is meant for securing transactions and serves a powerful container technology for smart contract development in the global capital firms. The potential of Blockchain and DLT in capital markets in this upcoming world could remove many of the inefficiencies and costs inherent in the global capital markets across the world and could be considered as a viable technology which enable to settlement.

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