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 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.
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
Examples of Managed health care in a sentence
Managed health care plans shall submit the documentation the department may require to demonstrate compliance with this subdivision.
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: 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 plans such as HMOs and PPOs often require authorization before they provide reimbursement for mental health services. It may be necessary to seek approval by calling your insurance company for pre-approval prior to services being covered. If your carrier requires periodic updating of authorization for on-going sessions, it may be necessary for me to submit written treatment plans that include diagnosis and symptoms in order for them to authorize treatment. Should you choose to submit claims to your insurance company for reimbursement, your policy may require me to disclose this personal information to the company in the treatment plans, via phone inquiries from them and on the claim statements. If this office files claims for you, understand that in Maryland I am permitted to send some information without your consent. They usually require a clinical diagnosis, sometimes additional clinical information such as treatment plans, summaries, or copies of your record. In such situations, I will make every effort to release only the minimum personal information necessary for the purpose requested. Maryland law prevents insurers from making unreasonable demands for information, but there are no specific guidelines about what “unreasonable” includes. If I believe that your health insurance company is requesting an unreasonable amount of information, I will call it to your attention and we can discuss what to do. You can instruct me not to send requested information, but this could result in claims not being paid and the financial responsibility being placed on you. Though all insurance companies claim to keep such information confidential, we have no control over what they do with it once it is in their hands or computers. By signing this agreement, you agree that I can provide requested information to your carrier. Your signature indicates that you have read, and understand, the information and the HIPAA notice form and agree to the terms described. Patient Signature Printed Name Date
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 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 plans such as HMOs and PPOs often require 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. 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. 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 follow HIPAA guidelines to release only the information that you have permitted me to convey to the insurance carrier. You should know that 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. 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 means an arrangement through which utilisation of health care is monitored through the use of mechanisms which are designed to monitor appropriateness, promote efficacy, quality and cost effectiveness of the delivery of relevant health services;