| HMO Liability for Failure to Authorize Treatment |
| Patients can sue their HMOs for the wrongful refusal to authorize treatment in order to obtain reimbursement of money paid for medical services that should have been authorized. Thus, patients can sue their HMOs for the failure to pay for the treatment. However, patients (or, if the patient has died, his or her family members) cannot recover for any damages that resulted from not authorizing the treatment or from a delayed treatment. More... |
| Certificates of Need |
| Certificate of need programs are regulatory processes that assign the responsibility of addressing access, quality, and cost issues related to healthcare delivery to state reviewers. In states that have certificate of need programs, hospitals and health care providers cannot open, expand or add services without complying with the state's certificate of need program requirements.More... |
| HIPAA and Administrative Simplification |
| The Health Insurance Portability and Accountability Act of 1996 includes administrative simplification provisions, which are designed to bring the health care industry into the e-commerce information age. Pursuant to that law, the U.S. Department of Health and Human Services has adopted national standards for electronic transmission of health care transaction information. More... |
| The ABCs of Medicare Part A and Part B |
| Medicare is an entitlement program. Medicare Part A covers most hospital costs. Part B covers some doctor services and outpatient expenses at a clinic or emergency room. Neither Part A nor Part B covers routine physical exams, glasses, hearing aids, or dentures. More... |
| Medicaid Coverage for Family Planning Services |
| Federal law mandates that all state Medicaid programs cover family planning services and supplies to individuals of childbearing age. States are free to choose what family planning supplies and services to provide as long as they are "sufficient in amount, duration and scope to reasonably achieve their purpose."More... |
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