by: AllMed Healthcare Management
Eye wear may be a fashion accessory, but when you depend on it for seeing the world, it?s a lot more. Today, many people are turning to refractive laser eye surgery, such as Lasik surgery, to improve their vision. However, this high-cost surgery is normally not paid for by insurance because it fails to meet the conservative therapy test and is classified as cosmetic. This trend is shifting.
We are seeing an increasing number of circumstances where refractive eye surgery is determined to be medically necessary and, therefore, payable by the insurance provider. For example, if conservative therapy treatments fail or if a patient is intolerant of contact lenses and cannot wear glasses because they might pose a risk in their job (e.g. police or firefighters), refractive eye surgery may be the most medically viable treatment option.
Conservative Therapy Options:
Examples of conservative therapy treatments include the following:
Photorefractive keratectomy (PRK) ? a refractive laser surgical procedure that is often done (and covered) for a patient that suffers from recurrent corneal erosion (e.g. diabetics). With PRK, a laser is used to remove corneal tissue to correct vision problems.
Patching, epithelial debridement (mechanical removal of faulty tissue), and bandaged contact lens placement ? treatments that often don?t work.
Stromal puncturing ? a procedure involving the physician puncturing the anterior corneal stroma ? can also be used but can fail or result in permanent vision loss. In such cases, PRK is the best alternative for removing the damaged cells (or membranes) and possibly correcting the vision problems.
Physicians can help patients who are in medical need of laser eye surgery make a stronger case by initiating the following:
Document a full medical history of the patient?s eye complaints
Show proof that the patient has not responded to conservative treatments and that the purpose of the surgery is for medical reasons other than simply improved eyesight
Still, even when the physician does this, each decision is taken on a case-by-case basis and is subject to the extenuating circumstances clearly noted in the patient?s medical record.
For more information about medical necessity reviews on cases like this, visit our website or call us at 1-800-400-9916.
About The Author
AllMed Healthcare Management Founded in 1995, AllMed (http://www.allmedmd.com, http://www.allmedmd.com/blog/index.htm) is a URAC-accredited Independent Review Organization (IRO) serving insurance payers, providers, TPAs and claims managers nationwide. Reviews are conducted by board-certified physicians in active practice. AllMed's growing customer base includes premier organizations, such as Educator's Mutual Life, IMS Managed Care, Tenet Healthcare Corporation, HealthGuard, several Blue Cross Blue Shield organizations, TriWest Healthcare Alliance, Allianz and many other leading healthcare payers.
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Health Insurance
Health Insurance
by: Sara Chambers
When you are in your late teens and twenties, possibly up to the age of forty, it?s hard for people to understand why they need health insurance.
For some people, it may be less expensive to pay full price when going to the doctor then pay the monthly fee associated with health insurance.
These people may ask whether or not health insurance is even worth it.
For most people, however, health insurance is a huge money saver.
But what are the different types of health insurance and how should you go about determining what is right for you.
There are mainly two types of insurance:
Indemnity plans and managed care plans.
Indemnity plans are insurance plans in which an insurer reimburses the insured for medical expenses no matter who provided the service.
There are three plans within the indemnity category.
These include reimbursement of actual...
Insurance > Health Insurance
Online Insurance: The End of the High Street Broker?
Online Insurance: The End of the High Street Broker?
by: George McGonigal
Once the insurance salesman visited you, then you visited his office.
Now you pick up your phone or click your mouse. Does the Internet herald the end of the high street insurance broker in Britain? When I was a lad, some 25 years ago, the Insurance Company called to your door every month to collect your life insurance premium. My recollection is of a drab suited man having to run the gauntlet of neighbourhood dogs rather like the postman.
Then through the eighties more and more people found their wages being deposited directly into hastily set up bank accounts; this led to the standing order for paying all sorts of regular bills including insurances and heralded the demise of the door to door representative. An economy quickly realised by big insurance companies in the UK.
Then during the nineties big firms latched on to the idea of ?direct? which is a...
Online Insurance: The End of the High Street Broker?
Insurance > Online Insurance: The End of the High Street Broker?
Why This Lawyer Says You Should Buy Car Insurance From An Independent Broker
Why This Lawyer Says You Should Buy Car Insurance From An Independent Broker
by: Philip L. Franckel, Esq.
I don't sell car insurance, but as a lawyer practicing in the field of personal injury I frequently see people suffer because they have the wrong insurance coverage. Often, this happens because they purchased directly from an insurance company instead of an independent broker.
Many of my clients who have been seriously hurt in a car accident were struck by someone who had no insurance or only the minimum liability insurance coverage, which is $25,000 in New York and much less in many other states. Unfortunately, many of my clients were sold insurance policies with liability limits of $100,000 or $300,000, but were not sold matching uninsured and underinsured coverage.
Just this week, yet another new client had this problem. My client was a pedestrian crossing the street when she was struck by a car which fled the scene. The driver...
Why This Lawyer Says You Should Buy Car Insurance From An Independent Broker
Insurance > Why This Lawyer Says You Should Buy Car Insurance From An Independent Broker
Critical Illness Insurance ? Critical Or Ridicule?
Critical Illness Insurance ? Critical Or Ridicule?
by: Rachel Lane
Critical illness cover (CIC) is a type of insurance which provides a significant one-off payment if you are diagnosed with a specified life-threatening condition ? specified being the important term, because if your illness isn?t in the terms and conditions ? you won?t get the payment.
Over recent years, critical illness cover has gained in popularity due to lower costs and apparent simplicity.
Critical illness insurance can be sold as part of a mortgage package or additionally as a stand-alone policy.
Critical illness cover can also be commonly associated with life insurance, with certain CIC policies paying out either on the diagnosis of a particular illness or on death, but not both, whilst other CIC policies pay out in both events.
When you first purchase the critical illness insurance policy, there might be an option for buy-back insurance, this would...
Critical Illness Insurance ? Critical Or Ridicule?
Insurance > Critical Illness Insurance ? Critical Or Ridicule?
How Much Insurance Do I Need?
How Much Insurance Do I Need?
by: Jeff Lakie
Insurance is a complicated business, and it can be unpleasant to talk about because no one likes talking about death? especially their own death! Because of those two reasons, many people do not think about insurance very much. However, most people should have some kind of insurance.
But how can you tell what kind of insurance you need? It is such as specialized industry, with insurance brokers requiring licenses in order to understand it and sell it, so it can sometimes make you feel like you are at the doctor and you have no idea what the doctor is talking about! What makes matters worse, is that insurance brokers (the only people who know what they're talking about) are usually paid by commission based on the amount they sell. So, while you are likely to get an insurance broker who is a good, ethical person, you might still be concerned that they are overestimating your need.
So how much do...
How Much Insurance Do I Need?
Insurance > How Much Insurance Do I Need?
5 Top Things Baby Boomers Must Do Before Starting a Home Based Business
5 Top Things Baby Boomers Must Do Before Starting a Home Based Business
by: Patty Gale
Don't quit your day job just yet.If you are a baby boomer looking to start a home business, there are 5 essentials things you must do first.
Leaving the security of a job with an established 401(k) plan, health insurance or other benefits can create a real tug of war for baby boomers who want to pursue their dreams of owning their own business.
Analyze Your Exit Strategy
At the time of this writing, the youngest of the baby boomers are turning 42 and the oldest are turning 60.
No matter where you fall into this group, analyzing and preparing your exit strategy from your job will be crucial to your long-term success as a home business entrepreneur.
Do you have adequate savings?
If you're married, will you be able to participate in your spouse's health insurance?
Create a Financial Plan
How much is your salary...
5 Top Things Baby Boomers Must Do Before Starting a Home Based Business
Insurance > 5 Top Things Baby Boomers Must Do Before Starting a Home Based Business
The Life Insurance Policy and What You Need to Know Before You Buy
The Life Insurance Policy and What You Need to Know Before You Buy
by: Don Adams
Are you looking to buy a life insurance policy?
Well, be careful. Life insurance can be difficult to understand and it's easy to be conned into buying something under false pretenses.
Recently a prominent life insurance company together with several of its agents paid a huge fine because it permitted the sale of a life insurance policy disguised as a retirement plan.
There was little attention given to what a life insurance policy is truly designed to provide.
Life insurance is not an investment for your benefit.
It's guaranteed income tax-free cash paid to someone you designate in the event of your death.
If you deeply care for someone and want to protect them, then buying a life insurance policy makes sense.
As primary bread winner in your family, your lost income could jeopardize the ability of those you love to...
The Life Insurance Policy and What You Need to Know Before You Buy
Insurance > The Life Insurance Policy and What You Need to Know Before You Buy
How Do I Choose A Good Insurance Company For My Needs?
How Do I Choose A Good Insurance Company For My Needs?
by: Matt Clarkson
It?s easy to see which company is least expensive, but when you need them to cover a claim, what kind of job will they do? To put it another way, which is the most reliable insurance company?
Here?s some quick tips to help you choose the right insurance company for you.
- Visit your state's department of insurance and check consumer complaint ratios and basic rate comparison surveys.
- Get in touch with local body medical practitioners you trust and ask which insurance companies they recommend.
- Consider contacting an insurance agent for additional information about a particular insurance company.
- Check out the financial strength ratings for an insurance company by referring to the A.M. Best and Standard & Poor's ratings.
There?s so much to think about when looking for the right insurance company; we?ve already...
How Do I Choose A Good Insurance Company For My Needs?
Insurance > How Do I Choose A Good Insurance Company For My Needs?
Insurance
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