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The Non-Insured Health Benefits (NIHB) program provides medically necessary coverage for eligible First Nations and Inuit in Canada. It is administered by Health Canada and covers benefit claims for certain drugs, dental care, vision care, medical supplies and equipment, short-term crisis intervention mental health counselling, and medical transportation. [1]
Objective: To determine whether 340B covered entities pay more than the statutory defined 340B ceiling price and, if so, the potential reason for the price discrepancies. [ 45 ] Findings : (1) In June 2005, 14 percent of total purchases by 340B entities exceeded 340B ceiling prices, resulting in total overpayments of $3.9 million.
Status First Nations individuals qualify for a set number of visits to the optometrist and dentist, with a limited amount of coverage for glasses, eye exams, fillings, root canals, etc. For the most part, First Nations people use normal hospitals and the federal government then fully compensates the provincial government for the expense.
An explanation of benefits (commonly referred to as an EOB form) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. [1] The EOB is commonly attached to a check or statement of electronic payment. An EOB typically describes:
The program was modelled on the Non-Insured Health Benefits Program provided by the federal government to First Nations and Inuit people. [12] Officials stated that complaints about that program, particularly about excessive paperwork for dental clinics, were addressed for the creation of the Canadian Dental Care Plan. [13]
Medical billing, a payment process in the United States healthcare system, is the process of reviewing a patient's medical records and using information about their diagnoses and procedures to determine which services are billable and to whom they are billed. [1] This bill is called a claim. [2]
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.
SCHIP covered 6.6 million children in 2006, [91] but the program is already facing funding shortfalls in many states. [92] The government has also mandated access to emergency care regardless of insurance status and ability to pay through the Emergency Medical Treatment and Labor Act (EMTALA), passed in 1986, [93] but EMTALA is an unfunded ...