Insurance Commons^™

Is Nevada A Reproductive Resource Desert?, Tsion Mekonnen

Research Publications

Nevada's reproductive health issues is specified in a list of statistical data. The data ranges from issues concerning women living in poverty, the uninsured population of men and women in Nevada, and the amount of women enrolled/eligible for benefits.

Patterns Of Health Care Use Among Rural-Urban Medicare Beneficiaries Age 85 And Older, 2010-2017, Yvonne Jonk Phd, Heidi O'Connor Ms, Amanda Burgess Mppm, Carly Milkowski Mph

Access / Insurance

The purpose of this study was to examine rural-urban differences in health care use among Medicare beneficiaries age 85+. Understanding these differences, and the socioeconomic characteristics that contribute to them, can have important implications for Medicare policies aimed at serving the age 85+ population. Using the Medicare Current Beneficiary Survey 2010-13 Cost and Use and 2015-17 Cost Supplement Files, we examined whether and how rural and urban Medicare beneficiaries age 85+ differ in terms of their:

1. socioeconomic and health characteristics that may inform health care use;
2. trends in health care use, including use of inpatient and emergency department (ED) care; …

Dentistry And The Law: Can Dental Plan Ratings Be Defamatory?, Dan Schulte Jd

The Journal of the Michigan Dental Association

This article discusses the legal implications of dental plan ratings for dentists. If a dental plan assigns a rating to dentists and publishes it to patients without providing specific information about the rating's basis or an opportunity for dentists to contest it, legal recourse may be limited. Currently, no statutory law regulates such ratings, leaving dentists potentially vulnerable to defamatory ratings. Under Michigan law, dentists could sue for defamation, but proving the rating's falseness and the resulting loss of patients may be challenging. Federal regulation is suggested to ensure fairness, transparency, and protection for dentists subjected to involuntary ratings.

Negotiating Reimbursement Rates With A Ppo Plan, Dana Moss

The Journal of the Michigan Dental Association

Dentists often struggle to negotiate reimbursement rates with dental insurance companies. This article discusses the importance of managing reimbursement from benefit plans and highlights the advantages and disadvantages of participating in insurance networks. It provides a step-by-step guide to negotiating insurance allowances effectively, emphasizing the need for preparation, data analysis, and communication skills. The article suggests ways to maintain profitability in practices with a significant PPO patient base. It includes recommendations for keeping fees balanced, choosing negotiation plans, and building relationships with insurance representatives. The emotional aspects of negotiation are also addressed, promoting a respectful and collaborative approach.

News You Need: Reminder: What You Must Know About Antitrust Law, Dan Schulte Jd

The Journal of the Michigan Dental Association

This reminder emphasizes the critical importance for dentists, particularly members of organizations like the Michigan Dental Association, to understand antitrust laws and their implications. The U.S. Justice Department and Federal Trade Commission actively pursue antitrust violations among physicians and dentists. The article outlines key aspects of the Sherman Antitrust Act, emphasizing that joint activities among independent dentists that restrain competition may lead to violations. The concept of joint action and the restraint on competition are explored, with a focus on potential pitfalls, such as price-fixing and group boycotts. Dentists are urged to stay informed to avoid legal consequences.

Advocacy Spotlight: Ada Lobbyist Conference Highlights Critical Advocacy Issues, Neema Katibai Jd

The Journal of the Michigan Dental Association

The ADA Lobbyist Conference highlighted crucial issues in dentistry, including Medicare reform, teledentistry, workforce concerns, and insurance challenges. State dental associations collaborated on building advocacy partnerships and shared successful grassroots engagement strategies. Medicare reform discussions focused on the ADA's opposition to Plan B inclusion and the impact of constituent outreach. State associations addressed Medicaid reform, emphasizing personal stories to convey the need for change. Teledentistry legislation and insurance company relationships were also key topics. The insights gained will shape the MDA's advocacy strategy for 2022.

Dentistry And The Law: Can I Be Reported To The Data Bank In Connection With A Billing Dispute?, Dan Schulte Jd

The Journal of the Michigan Dental Association

This Dentistry and the Law column addresses a dentist's concern about being reported to the National Practitioner Data Bank (NPDB) during a billing dispute. The dentist questions the validity of such a report, considering no issues with treatment quality are raised. The response emphasizes that adverse actions based solely on billing practices may not be reportable to the NPDB. Additionally, it clarifies that a dental plan administrator may not be eligible to make a Data Bank report, offering guidance on informing the plan about rights and potential contestation.

Navigating The Impact Of Covid-19 On Small Commercial Businesses And Insurance Companies, And A Call To Action For Future Communicable Disease Outbreaks, Natalie Peña

Honors Program Theses and Research Projects

The short-term and long-term effects of Covid-19 have caused many small commercial businesses to face financial hardships, loss of employees, and even closures for entities that were already experiencing low profit margins. Distraught with their businesses suffering, owners turned to their primary insurance companies to receive compensation through their business interruption policies. However, most insureds were upset when they discovered that their insurance plans did not include communicable diseases and pandemics as a covered peril. This led to many small businesses battling these issues in the courts and fighting for insurance companies to provide financial assistance to them during this …

The Impact Of Covid-19 On Hospital Admissions For Twelve High-Burden Diseases And Five Common Procedures In The Philippines: A National Health Insurance Database Study 2019-2020, Jhanna Uy, Vanessa T. Siy Van, Valerie Gilbert T. Ulep, Diana Beatriz Bayani, Damian Walker

Health Sciences Faculty Publications

Background

The Philippines has the highest cumulative COVID-19 cases and deaths in the Western-Pacific. To explore the broader health impacts of the pandemic, we assessed the magnitude and duration of changes in hospital admissions for 12 high-burden diseases and the utilization of five common procedures by lockdown stringency, hospital level, and equity in patient access.

Methods

Our analysis used Philippine social health insurance data filed by 1,295 hospitals in 2019 and 2020. We calculated three descriptive statistics of percent change comparing 2020 to the same periods in 2019: (1) year-onyear, (2) same-month-prior-year, and (3) lockdown periods.

Findings

Disease admissions declined …

Financing Mechanisms Applied For Successful Universal Health Coverage In Malaysia, Thailand And Singapore - Lessons For Pakistan, Rawshan Jabeen, Unaib Rabbani, Nazish Abbas

Community Health Sciences

Universal health coverage is a global agenda and, currently for Pakistan, achieving this goal is a challenge because of a number of constraints. The current narrative review was planned to describe an overview of the provision of health insurance in Malaysia, Thailand and Singapore that have achieved universal health coverage, and to propose a roadmap for Pakistan. Literature search was conducted on Google Scholar and PubMed databases as well as on the World Bank website to retrieve relevant articles. The three studied countries achieved universal health coverage by gradually increasing allocation for health and through various mechanisms, such as health …

J Mich Dent Assoc October 2021

The Journal of the Michigan Dental Association

Every month, The Journal of the Michigan Dental Association brings news, information, and features about Michigan dentistry to our state's oral health community and the MDA's 6,200+ members. No publication reaches more Michigan dentists!

In this issue, the reader will find the following original content:

• A cover story, “Welcoming Colleagues from Different Practice Models”.
• A feature article from the Journal’s DEI series, “Diversity, Equity, and Inclusion: Perspectives from an LGBTQ Dentist”.
• A feature article, “Congratulations, 2021 MDA Life Members!”.
• News you need, Editorial and regular department articles on MDA Foundation activities, Dentistry and the Law, Staff Matters, and component news. …

Financial Risk Protection For Neurosurgical Care In Indonesia And The Philippines: A Primer On Health Financing For The Global Neurosurgeon, Kevin Paul Ferraris, Maria Eufemia C. Yap, Maria Cristina G. Bautista, Dewa Putu Wisnu Wardhana, Sri Maliawan, I Made Ady Wirawan, Rohadi Muhammad Rosyidi, Kenny Seng, Joseph Erroll Navarro

Graduate School of Business Publications

Which conditions treated by neurosurgeons cause the worst economic hardship in low middle-income in countries? How can public health financing be responsive to the inequities in the delivery of neurosurgical care? This review article frames the objectives of equity; quality; and efficiency in health financing to the goals of global neurosurgery. In order to glean provider perspectives on the affordability of neurosurgical care in low-resource settings; we did a survey of neurosurgeons from Indonesia and the Philippines and identified that the care of socioeconomically disadvantaged patients with malignant intracranial tumors were found to incur the highest out-of-pocket expenses. Additionally; the …

J Mich Dent Assoc September 2021

The Journal of the Michigan Dental Association

Every month, The Journal of the Michigan Dental Association brings news, information, and features about Michigan dentistry to our state's oral health community and the MDA's 6,200+ members. No publication reaches more Michigan dentists!

In this issue, the reader will find the following original content:

• A cover story with “Reports from the Dental School Deans”, Dr. Mert Aksu and Dr. Laurie McCauley.
• A feature article from the Journal’s DEI series, “Building a Culturally Competent Practice”.
• A feature article, “Disability Insurance: 10 Things You Need to Know”.
• News you need, Editorial and regular department articles on MDA Foundation activities, Dentistry and …

An Examination Of Types Of Health Insurance And The Reported Prevalence Of Autism In The United States, Jennifer L. Thompson

Dissertations

The prevalence of Autism Spectrum Disorders continues to rise despite barriers of changes to diagnostic criteria and lack of insurance coverage. Increases in prevalence affect costs associated with a disorder since cost of health care services are often estimated based on utilization of services. This can also affect an individual’s ability to access to health care services. To equitably distribute autism services to individuals an accurate estimation of the true prevalence of autism is needed.

Access to health care can be influenced by the type of insurance coverage a person holds. Other factors, such as socio-economic status, ethnicity, location of …

J Mich Dent Assoc April 2021

The Journal of the Michigan Dental Association

In the April 2021 issue of the Journal of the Michigan Dental Association, we offer a comprehensive range of original feature content showcasing the latest developments in dental practice and knowledge, including:

1. AI in Dental Care Delivery: Explore the groundbreaking role of Artificial Intelligence (AI) and Machine Learning in dental care, revolutionizing efficiency, safety, care outcomes, and treatment planning consistency.
2. AI in Dental Claims Processing: Discover how AI is employed by third-party payers to streamline dental claims processing, resulting in cost containment and the proactive identification of potential fraud, waste, and abuse.
3. Evidence-Based Dentistry: As part of …

Using Decision Trees To Classify Factors That Predict Health Insurance Status Among Sexual Minority Women, Kayla Simon

2021 Honors Symposium

Background
• Social determinants of health (SODH) are factors that influence an individual's health status.
• SODH inequalities often negatively impact health status.
• LGBTQ+ individuals are more likely than their heterosexual counterparts to be unemployed and uninsured in early adulthood (Charlton, Gordon, Reisner, 2018).

Purpose
The purpose of this project is to build a machine learning model that predicts insurance status based on social determinants of health selected as input variables

J Mich Dent Assoc December 2020

The Journal of the Michigan Dental Association

Every month, The Journal of the Michigan Dental Association brings news, information, and features about Michigan dentistry to our state's oral health community and the MDA's 6,200+ members. No publication reaches more Michigan dentists!

In this issue, the reader will find the following original content:

• A cover story on “The Dentist’s Role in Recognizing Sleep-Related Breathing Disorders: A Two-Part Series”.
• The “2020 Author/Title Index to the Journal of the Michigan Dental Association”.
• News you need, Editorial and regular department articles on MDA Foundation activities, Dentistry and the Law, Staff Matters, and component news.

This issue also includes three articles reprinted …

Strategic Audit Of Optum, Connor Crow

Honors Program: Senior Projects (Public)

Optum is a large American-based pharmacy benefit manager, healthcare consultant, healthcare delivery service, and business analytics corporation that has dominated the industry with sister-company UnitedHealthcare underneath the umbrella UnitedHealthGroup. This report seeks to understand through internal and external analyses how Optum’s business model and strategies have allowed them to gain and sustain competitive advantages in the everchanging, volatile environment of healthcare. Specific tools used to highlight this include Porter’s Five Forces, PESTEL, and SWOT analyses. Additionally, strategic recommendations are given for Optum’s next steps.

J Mich Dent Assoc November 2020

The Journal of the Michigan Dental Association

Every month, The Journal of the Michigan Dental Association brings news, information, and features about Michigan dentistry to our state's oral health community and the MDA's 6,200+ members. No publication reaches more Michigan dentists!

In this issue, the reader will find the following original content:

• Feature articles on how “Routine Blood Lead Testing During Pregnancy Empowers Future Dental Caries and Neurotoxicity Research”, how to “Recoup Your Dues and More with MDA-Endorsed Programs”, and your “2021 MDA Membership Benefits Guide”.
• News you need, Editorial and regular department articles on MDA Foundation activities, Dentistry and the Law, Staff Matters, 10-Minute EBD, Headquarters …

Why Some People Consume Counterfeit Drugs In Benin, Maxime A. Ahouansou

International Programs

Despite the threat counterfeit drugs represent to health and the government’s endeavor to discourage their consumption, some people in Benin still prefer buying medicine in the underground economy. This research purported to understand the causes of the phenomenon. The research method used a survey of a sample of sixty-eight people randomly selected at Cotonou, a city with a population representative of Benin general population status regarding socio-economic conditions. The data about people's habits regarding drug consumption, monthly income, insurance coverage, and reasons why people chose to buy counterfeit medicines were collected and analyzed using Excel Spreadsheet. The analysis of those …

J Mich Dent Assoc May 2020

The Journal of the Michigan Dental Association

Every month,The Journal of the Michigan Dental Association brings news, information, and features about Michigan dentistry to our state's oral health community and the MDA's 6,200+ members. No publication reaches more Michigan dentists!

In this issue, the reader will find the following original content:

• A cover story on Michigan Dentistry in the COVID-19 Pandemic
• A message from the MDA President
• “Severe Acute Respiratory Syndrome Coronavirus-2: What Dental Professionals Need to Know” a feature on protecting the health of your patients and your dental team.
• “Keep the Lights On: Protecting the Health of Your Practice During the Economic Downturn” a …

J Mich Dent Assoc February 2020

The Journal of the Michigan Dental Association

Every month,The Journal of the Michigan Dental Association brings news, information, and features about Michigan dentistry to our state's oral health community and the MDA's 6,200+ members. No publication reaches more Michigan dentists!

In this issue, the reader will find the following original content:

• A cover story on the 2020 MDA Annual Session
• A feature covering student perspectives on the Opioid Crisis
• News you need, Editorial and regular department articles on MDA Foundation activities, Dentistry and the Law, Staff Matters, Headquarters Report, and component news

This issue also includes articles reprinted with permission:

• “Muscle Deprogramming: A Source of Confusion”, …

Ethical Imperatives Critical To Effective Disease Control In The Coronavirus Pandemic: Recognition Of Global Health Interdependence As A Driver Of Health And Social Equity, George A. Gellert Md, Mph, Mpa

Journal of Health Ethics

Ethical imperatives critical to effective disease control in the coronavirus pandemic: Recognition of global health interdependence as a driver of health and social equity

George A. Gellert MD, MPH, MPA

ABSTRACT

Decades into the era of emerging infectious diseases, the 2019-2020 coronavirus pandemic has caught the world, and the United States in particular, poorly prepared to engage effective public health disease prevention and control measures. In part, this reflects poor public health planning, response, logistical preparation and pandemic readiness, and complacency by governments and disease control agencies. In terms of future responses to emerging infection pandemics, these deficiencies can be …

Three Essays On Health Economics And Policy Evaluation, Shishir Shakya

Graduate Theses, Dissertations, and Problem Reports (ETD)

This dissertation consists of three essays on the U.S. Health care policy. Each paragraph below refers to the three abstracts for the three chapters in this dissertation, respectively. I provide quantitative evidence on how much Prescription Drug Monitoring Programs (PDMPs) affects the retail opioid prescribing behaviors. Using the American Community Survey (ACS), I retrieve county-level high dimensional panel data set from 2010 to 2017. I employ three separate identification strategies: difference-in-difference, double selection post-LASSO, and spatial difference-in-difference. I compare how the retail opioid prescribing behaviors of counties, that are mandatory for prescribers to check the PDMP before prescribing controlled substances …

Injury Surveillance In Community Cricket And The Exploration Of Insurance Claims Systems, Geordie Mcleod

Theses: Doctorates and Masters

The aims of this industry funded PhD thesis were 1) To understand the injury causes, trends and burden in community cricket and 2) To examine the Cricket Australia National Club Risk Protection Program (NCRPP) insurance scheme for suitability as an injury surveillance tool for community cricket.

This thesis sought to identify and understand the injury profile of community cricketers through existing literature and injury datasets, being, Victorian Injury Surveillance Unit (VISU) hospital data, Accident Compensation Corporation (ACC) and NCRPP insurance claims data. This thesis also undertook a novel assessment of data validity and completeness from various sources, against industry standards …

"The Healing Of America" And The Next Steps For American Healthcare, Carter A. Hanson

Student Publications

An exploration of three healthcare systems—France, United Kingdom, and Canada—and what can be learned for them. Elements from the three national systems are combined into a proposal for reforming the American healthcare system into a devolved single-payer system.

The Impacts Of Insurance And Billing Considerations On The Practice And Attitudes Of Genetic Counselors, Emily Krosschell

Dissertations and Theses (Open Access)

Genesurance counseling has been identified as an integral part of many genetic counseling sessions, but little is known about the workflow impacts and genetic counselor perceptions of genesurance-related tasks. In this study, we aimed to characterize how insurance and billing considerations for genetic testing are being incorporated into genetic counselors’ practice; as well as describe current attitudes and challenges associated with their integration. An electronic survey was sent by email to members of the National Society of Genetic Counselors (NSGC). A total of 325 genetic counselors that provided direct patient care were included in data analysis. Results showed that the …

Industry Spotlight: Medical Devices, Evan D. Poff

Marriott Student Review

Medical devices restore and even redefine health. This Industry Spotlight examines pre-market barriers, medtech business model quirks, current and future developments in the field, and the present-day move to value-based care in the medical device industry.

The Effect Of Lowering Public Insurance Income Limits On Hospitalizations For Low-Income Children., Jessica L. Bettenhausen, Matt Hall, Jeffrey D. Colvin, Henry T. Puls, Paul J. Chung

Manuscripts, Articles, Book Chapters and Other Papers

Background and objectives: Thirty million children are currently covered by public insurance; however, the future funding and structure of public insurance are uncertain. Our objective was to determine the number, estimated costs, and demographic characteristics of hospitalizations that would become ineligible for public insurance reimbursement under 3 federal poverty level (FPL) eligibility scenarios.

Methods: In this retrospective cohort study using the 2014 State Inpatient Databases, we included all pediatric (age

Results: In 775 460 publicly reimbursed hospitalizations in 14 states, reductions in eligibility limits to 300%, 200%, or 100% of the FPL would have resulted in large numbers of newly …

Self-Inflicted Injuries: Designation For Risk Assessment Or Cost Avoidance, Brianna M. Robertson, Ralph E. Mckinney Jr., Lawrence P. Shao

Psychiatry

This paper considers the denial of health insurance benefits based on a participant's high-risk behaviors such as self-inflicted injuries. In many instances, healthcare benefits can be denied if patients are injured while engaging in criminal activities, from a self-infliction, and from injuries relating to the consumption of alcohol. With increases in healthcare expenditures and government regulation, the necessity for benefit reductions is directed at individuals engaging in high-risk behaviors. The belief is that high-risk behaviors can be modified by individuals. Unfortunately, modification of behaviors may not be available to everyone.