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Unlike EPO members, however, PPO members are reimbursed for using medical care providers outside of their network of designated doctors and hospitals. However, when they use out-of-network providers PPO members are reimbursed at a reduced rate that may include higher deductibles and co-payments, lower reimbursement percentages, or a combination ...
North Carolina State Board of Dental Examiners v. Federal Trade Commission , 574 U.S. 494 (2015), was a United States Supreme Court case on the scope of immunity from US antitrust law . The Supreme Court held that a state occupational licensing board that was primarily composed of persons active in the market it regulates has immunity from ...
Anti-competitive agreements: Firms may enter into agreements that limit competition, such as agreements to fix prices, limit production or supply, or divide markets. These agreements harm competition, reduce consumer choice and lead to higher prices or lower quality products or services.
The National Institute of Dental and Craniofacial Research carried out further research into dental care for minorities and found that black and Hispanic families in lower-income areas had much higher incidences of tooth decay. [12] Similar research shows that poor dental hygiene directly affects educational abilities and school attendance. [13]
The process of introducing a consent decree begins with negotiation. [5] One of three things happens: a lawsuit is filed and the parties concerned reach an agreement prior to adjudication of the contested issues; a lawsuit is filed and actively contested, and the parties reach an agreement after the court has ruled on some issues; or the parties settle their dispute prior to the filing of a ...
An acceptance is an agreement, by express act or implied from conduct, to the terms of an offer, including the prescribed manner of acceptance, so that an enforceable contract is formed. [ 2 ] In what is known as a battle of the forms , when the process of offer and acceptance is not followed, it is still possible to have an enforceable ...
On January 15, 2009, UnitedHealth Group announced a $350 million settlement of three class action lawsuits filed in Federal court by the American Medical Association, UnitedHealth Group members, healthcare providers, and state medical societies for not paying out-of-network benefits. This settlement came two days after a similar settlement with ...
With indemnity dental plans, the insurance company generally pays the dentist a percentage of the cost of services. Restrictions may include the co-payment requirements, waiting period, stated deductible, annual limitations, graduated percentage scales based on the type of procedure, and the length of time that the policy has been owned.