Archive for July, 2010


Denied For Health Insurance

Posted under Articles by baryant

Nowadays  people applying for health insurance underwriting to exclude relevant detail during the initial statement of the applicant’s medical history or, more specifically the use of certain medications, drugs. Most often, potential applicants think that it has no real significance, but the application of medical insurance, not taking into account the current or previous state of health of the insured person is offered only to discover the consumption of drugs indicates a high degree of risk and may lead to a decline. List of drugs, carefully carefully underwriter of health insurance is extensive, but the question most applicants ask, how do they get this information in the first place? I wanted to write this article so potential applicants can better understand and prepare themselves so they do not get prematurely rejected by the insurer but first let’s look at the role of two popular high-compliant database used during the underwriting process, known as the Medical Information Bureau and the management of pharmacy benefit .

To date, most of the public are already aware of the medical information the Bureau of nonprofit organizations that share and exchange information of the applicant member insurance companies. Medical Information Bureau contains no detailed electronic medical records in the repository collections, such as reading an electrocardiogram, blood test results and other diagnostic tests that can have real meaning and value to insurance companies. Instead, the database contains the codes that serve as a warning to the medical underwriting process and in most cases, if the claimant had a group insurance for most of his life and does not apply to individual private health insurance, lack of communicable information in this case the insurance company are likely to ask the attending physician statement known as APS or the insurer will request the medical examination. Even will all of these protocols to investigate the proposed insured is still the possibility that vital information is missing, especially if the attending physician statement, there is no documentation and records from the applicant the prescribed medications from another practitioner of medicine, such as a specialist. There are many databases that are used in health insurance underwriting, and one of them used more often today involves the use of pharmacy benefit management.

Pharmacy Benefit Manager is the third-party administrator of prescription drug programs. They are primarily responsible for processing and payment of claims for drugs. They are also responsible for developing and maintaining the formulary, contracting with pharmacies, and negotiate discounts or rebates from pharmaceutical manufacturers. The focus on medication management contributed to the deployment of the various interrelated systems. Typically, the control system includes a treatment of four key areas: prescription, transcription, dispensing, and administration. Covers prescription writing patient orders medication. Transcription involves the transmission of orders for review and development activities in the pharmacy. Rental covers the preparation for the delivery of patient medications. Medicines Management encompasses activities related to the provision of drugs to patients. Let’s look in more detail.

Purpose: The electronic prescription is through the use of computerized order entry practices (CPOE) systems. Functionality inherent in these systems varies greatly depending on the intended user, such as doctors or case management. CPOE often includes clinical decision support (CDS). CDS during medication administration regularly uses drugs databases, which provide interaction between the drug and dose verification of information during the initial phase of prescription medication.

Transcription: The transcription uses the pharmacy system, which helps the pharmacist orders medication process and assist in the pharmacy management. In addition, these systems often offer a treatment of testing by the pharmaceutical data bases similar to those used during the phase of prescription drug management.

Vacation: Vacation drugs occur via the illegal use of different devices, which are systematically associated with this integrated system pharmacy. These are robots that select one drug dose and pack them together to deliver the patient and the issuance of the cabinets, located in fixed areas, which facilitate the collection of accurate medication. These cabinets containing the most commonly administered drugs, using a visual cue, such as automatic lighting tray, or one opened the box to indicate the correct location of a nurse treating the patient. Cabinets use patient information obtained manually by a nurse and entered into a computer connected to the cabinet or, more accurately, the electronic pharmacy systems, control room logic.

Administration: The administration is working to ensure the five rights of medication administration, patient’s rights, the right drug, right dose, right dose, right route and right time. Systems used at this stage often use bar coding and patients, and medications to ensure the accuracy and tracking medication administration. In addition, bar codes, radio frequency identification devices (RFID) tags are currently deployed to assist in the treatment of management. Tags consist of a microchip with an antenna that interacts with electromagnetic waves to exchange information. Capabilities of these tags vary from passive stationary device data from battery-powered data modifiable chips. RFID is also used to track people and supplies.

It is important to understand side-effect of all this, when you go to the drugstore to pick up the medication the same retention system is intended to disseminate knowledge about your condition, to all HIPPA covered entities under the Health Insurance and Accountability Act, including doctors, physicians, pharmacies and insurance companies.

By now many of you readers probably given as to why all this information is still relevant. So I am writing this to show you that not registered in the medical information can often be contained in the pharmacy benefit management databases. Consider that some medications such as Cymbalta, Lexapro, Wellbutrin, Oxycotin, Limictal, and lithium-just to name some of them immediately a red flag for most insurers. Insurers are likely to approve of the applicant, if they can not justify the use of these drugs was on the situational circumstances as may be depressed because of death in the family or break the pain due to accidental injury. That insurers worry about the drug or chemical dependency and behavioral disorders that are relevant and progressive.

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