Managed health care means any one of the alternative deliveries of regular fee-for-service Medicaid such as defined in subrules dealing with health maintenance organizations (HMOs), prepaid health plans (PHPs), or Medicaid Patient Access to Service System (MediPASS).
Managed health care plans such as HMO's and PPO's are often limited to short-term treatment approaches designed to work out specific problems that interfere with a person's usual level of functioning. It may be necessary to seek approval for more therapy after a certain number of sessions. While much can be accomplished in short-term therapy, some patients feel that they need more services after insurance benefits end. You should also be aware that your contract with your health insurance company requires that I provide it with information relevant to the services that I provide to you. I am required to provide a clinical diagnosis, date of service, type of service rendered and fees. Sometimes I am required to provide additional clinical information such as treatment plans or summaries, or copies of your entire Clinical Record. In such situations, I will make every effort to release only the minimum information about you necessary for the purpose requested. This information will become part of the insurance company files and will probably be stored in a computer. Though all insurance companies claim to keep such information confidential, I have no control over what they do with it once it is in their hands. In some cases, they may share the information with a national medical information databank. I will provide you with a copy of any report I submit, if you request it. By signing this Agreement, you agree that I can provide requested information to your carrier. At your request, once you obtain information about your insurance benefits, I would be glad to help you review them so that we can discuss what we can expect to accomplish with the benefits available. We can also then discuss what might happen if benefits run out before you feel ready to end your sessions. It is important to remember that you always have the right to pay for my services yourself to avoid the problems described above. Your signature below indicates that you have read the information in the document and agree to abide by its terms during our professional relationship. Name Date
Managed health care means clinical and financial risk assessment and management of health care, with a view to facilitating appropriateness and cost effectiveness of relevant health services within the constraints of what is affordable, through the use of rules-based and clinical management- based programmes.
Examples of Managed health care in a sentence
Nothing in this section prohibits the Insurance Department from investigating violations of this section or from pursuing civil or criminal penalties for violations of this section in accordance with Section 31A-31-109 and this title.Amended by Chapter 193, 2019 General Session 34A-2-111 Managed health care programs -- Other safety programs.
Managed health care plans shall submit the documentation the department may require to demonstrate compliance with this subdivision.
Managed health care: US evidence and lessons for the National Health Service.
Managed health care plans such as HMOs and PPOs often require advance authorization before they will provide reimbursement for mental health services.
The patient manager will be responsible for attempting to correct uti- lization behavior of recipients who appear from utilization reports to be inappropriate utilizers of medi- cal services.88.51(3) Managed health care advisory committee.
More Definitions of Managed health care
Managed health care means any of the options for alternative delivery of Medicaid services that provides coordinated delivery of health care. The current options offered by the department are Medicaid patient management, known as MediPASS, health maintenance organization (HMO) enrollment and prepaid health plan (PHP) enrollment.
Managed health care is the coordinated delivery of health care managed by a designated health care provider responsible for directing or monitoring such care.
Managed health care plans such as HMOs and PPOs may require authorization before they provide reimbursement for mental health services. These plans are sometimes limited to short-term treatment approaches designed to work out specific problems that interfere with a person’s usual level of functioning. It may be necessary to seek approval for more therapy after a certain number of sessions. You should also be aware that filing a claim with your health insurance company requires that I provide it with information relevant to the services that I provide to you. I am required to provide a clinical diagnosis. Sometimes I am required to provide additional clinical information such as treatment plans or summaries, or copies of your entire Clinical Record. In such situations, I will make every effort to release only the minimum information about you that is necessary for the purpose requested. This information will become part of the insurance company files and will probably be stored in a computer. Though all insurance companies claim to keep such information confidential, I have no control over what they do with it once it is in their hands. In some cases, they may share the information with a national medical information databank or your employer. Once we have all of the information about your insurance coverage, we will discuss what we can expect to accomplish with the benefits that are available and what will happen if they run out before you feel ready to end your sessions. It is important to remember that you always have the right to pay for my services yourself to avoid the problems described above.
Managed health care plans such as HMOs, Focused Outpatient Management Programs (FOMP) and PPOs often require authorization before they provide reimbursement for mental health services. These plans may limit my services to approaches designed to work out specific problems that interfere with a person’s usual level of functioning. It may be necessary to seek approval for more therapy after a certain number of sessions. While much can be accomplished within the insurance companies perimeters for psychotherapy, sometimes the patient and I feel that he/she needs services not covered by their insurance. You should also be aware that your contract with your health insurance company requires that you authorize me to provide it with information relevant to the services that I provide to you. If you are seeking reimbursement for services under your health insurance policy, you will be required to sign an authorization form that allows me to provide such information. I am required to provide a clinical diagnosis and dates of treatment. Sometimes I am required to provide additional clinical information such as treatment plans or summaries, or in rare cases, copies of your entire clinical record. In such situations, I will make every effort to release only the minimum information about you that is necessary for the purpose requested. This information will become part of the insurance company files and will probably be stored in a computer or cloud. Though all insurance companies claim to keep such information confidential, I have no control over what they do with it once it is in their hands. In some cases, they may share the information with a national medical information databank. I will provide you with a copy of any report I submit, if you request it. It is important to remember that you always have the right to pay for my services yourself to avoid the problems described above (unless prohibited by contract).
Managed health care often requires authorization before they provide reimbursement for mental health services. These plans are often limited to short-term treatment approaches designed to work out specific problems that interfere with a person’s usual level of functioning rather than expanding or increasing the breadth of one’s experiential possibilities. It may be necessary to seek approval for additional therapy after a certain number of sessions, which the insurance company may or may not be willing to provide. Some managed- care plans will not allow me to provide services to you once your benefits end. If this is the case I will do my best to secure another provider who will help you continue with your psychotherapy. You should also be aware that your contract with your health insurance company requires that I provide it with information relevant to the services I provide to you. I am required to provide a clinical diagnosis. Sometimes I am required to provide additional clinical information such as treatment summaries, plans or even your entire clinical record. In such circumstances I will make every effort to release the minimal amount of information about you that is necessary for the purpose requested. This information will become part of the insurance company’s files and will probably be stored in a computer. Although all insurance companies claim to keep such information confidential, I have no control over what they do with it once it is processed by them. In some cases it is shared with a national information databank that other insurers may use in the future to determine your eligibility for health insurance, and in some cases people have been denied health coverage for having used mental health benefits. I will provide you with a copy of any report I submit, if you request it. By signing this agreement, you agree that I can provide requested information to your carrier. It is important to remember that you always have the right to pay for my services yourself to avoid the problems described above unless specifically prohibited by contract.
Managed health care means an integrated system of insurance
Managed health care means clinical and financial risk assessment and management of health care, with the view to facilitating appropriateness and cost-effectiveness of relevant health care services within the constraints of what is affordable, through the use of rule-based and clinical management-based programmes” (South Africa, Medical Schemes Act 1998, section 15).