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HMOs and insurers manage their costs better than risk-assuming healthcare providers and cannot make risk-adjusted capitation payments without sacrificing profitability. Risk-transferring entities will enter into such agreements only if they can maintain the levels of profits they achieve by retaining risks. [4] [6]
Despite a perception that IPAs have been formed to negotiate as a group with insurance companies in an attempt to improve rates of compensation, under the Federal Trade Commission Act, they cannot negotiate as a group with insurance companies for the providers' other insurance reimbursement. The IPA can only negotiate for the IPA members those ...
Unlike capitation, bundled payment does not penalize providers for caring for sicker patients. [ 5 ] Considering the advantages and disadvantages of fee-for-service, pay for performance , bundled payment for episodes of care, and global payment such as capitation, Mechanic and Altman concluded that "episode payments are the most immediately ...
Medicaid estate recovery is a required process under United States federal law in which state governments adjust (settle) or recover the cost of care and services from the estates of those who received Medicaid benefits after they die. By law, states may not settle any payments until after the beneficiary's death.
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A class action lawsuit filed against T-Mobile alleges the company charges a hidden fee by misleading customers since 2004. ... according to a complaint filed in California federal court by 23 ...
Your car insurance typically covers family members and friends who infrequently borrow your car, but understanding the coverage limits helps protect you from unexpected costs.
In 2006, the Legislature passed and the Governor signed Assembly Bill 774, adding section 127405 to the California Health and Safety Code. Among its provisions, the statute protects families under 350 percent of the poverty level from paying inflated hospital charges, beyond the rates hospital charge under the Medicaid or Medicare programs. [13]