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nH Predict is a computer program developed by naviHealth that implements an algorithm that has allegedly been used by health insurance companies including United Healthcare and Humana [1] [2] to automatically deny coverage to patients. [3] [4] [5] It is reported to work by cross-correlating patient health records with those of other patients. [6]
UnitedHealthcare (UHC) is an insurance and managed care company with four main divisions: UnitedHealthcare Employer and Individual – provides health benefit plans and services for large national employers and individuals. UnitedHealthcare Medicare and Retirement – provides health and well-being services to individuals age 65 and older. [80]
In an effort to increase mental health, all UHC centers offer behavioral/mental health services. [23] Once a patient is viewed as being under mental distress, the primary care provider will inform the patient of the services that they offer to help them cope, and will bring in the Case Manager into the room and introduce them.
Feb. 2014: Optum purchases a majority stake in Audax Health Solutions, a patient engagement [clarification needed] company. Audax is later rebranded as Rally Health. April 2015: Optum acquires MedExpress, an urgent care and preventative services company. [9] July 2015: Catamaran, a pharmacy benefit manager, joins OptumRx. [3]
The only forms of government-provided healthcare available are Medicare (for elderly patients above age 65 as well as people with disabilities), Medicaid (for low-income people), [36] [37] the Military Health System (active, reserve, and retired military personnel and dependants), and the Indian Health Service (members of federally recognized ...
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In the United States, a pharmacy benefit manager (PBM) is a third-party administrator of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program, and state government employee plans.
California's Office of the Patient Advocate was established July 2000 to publish a yearly Health Care Quality Report Card [49] on the top HMOs, PPOs, and Medical Groups and to create and distribute helpful tips and resources to give Californians the tools needed to get the best care. [50]