ライフサイエンスコーパス: insurer

1 t survives to care for helpless young ("life insurers").

2 diagnosis and had Medicare as their primary insurer.

3 quired PA by at least one Medicare Advantage insurer.

4 01-2017, using data from a nationwide health insurer.

5 udy used medical claims data from a large US insurer.

6 Claims from a large national health insurer.

7 e manufacturer to the distributor and to the insurer.

8 Setting: Claims from a large national health insurer.

9 that were submitted to a large, national US insurer.

10 th for the laboratory and for the patient or insurer.

11 rom a large, national US managed care health insurer.

12 64 years enrolled in a large national health insurer.

13 ht thing" may not be covered by the payer or insurer.

14 alth care expenditures borne by patients and insurers.

15 gical malpractice claims from four liability insurers.

16 has been adopted for use by many commercial insurers.

17 ison groups of enrollees covered by the same insurers.

18 were administered by three large nationwide insurers.

19 edures covered by Medicare and other private insurers.

20 e extent of genetic discrimination by health insurers.

21 uming a substantial ongoing role for private insurers.

22 d for treatment, 28% were denied coverage by insurers.

23 , state governments, and private health care insurers.

24 of utilization would have required PA by all insurers.

25 ed coverage without cost sharing for private insurers.

26 benefit patients, physicians, and healthcare insurers.

27 M vs MA, overall and across the 7 largest MA insurers.

28 Medicare, and $1369 ($456-$4078) for private insurers.

29 utilization rates vary among the largest MA insurers.

30 abase built on data voluntarily submitted by insurers.

31 enditures by Medicare, Medicaid, and private insurers.

32 at 10 years for patients and private health insurers.

33 e in the US: Medicare, Medicaid, and private insurers.

34 han TM, with varying degrees across large MA insurers.

35 uggesting findings may generalize to smaller insurers.

36 applied for insurance, 60% were rejected by insurers.

37 corporate hospital chains and large private insurers.

38 guideline recommended and widely covered by insurers.

39 d concurrent ACO contracting with commercial insurers.

40 supported by public healthcare or by private insurers.

41 he accuracy of network directories posted by insurers.

42 ter hospital pricing leverage against health insurers.

43 lenges to patients, families, providers, and insurers.

44 ut may also affect patients covered by other insurers.

45 ation would have required PA by at least one insurer; 12% of spending and 6% of utilization would hav

46 parity for telehealth services among private insurers; (2) authorization of audio-only telehealth ser

47 administrative data of a U.S. private health insurer (2000-2007 claims) to identify depression diagno

48 administrative data of a U.S. private health insurer (2000-2007 claims) to identify postdonation canc

49 007) to billing claims from a private health insurer (2000-2007 claims) to identify renal condition d

50 o administrative data of a US private health insurer (2000-2007 claims), we examined associations of

51 inked to billing records of a private health insurer (2003-2006 claims).

52 370.00 (95% CI, $430.70-$309.20) for private insurers, $281.00 (95% CI, $346.80-$215.30) for Medicare

53 In 2009, the VA billed private insurers $52.3 million to reimburse care provided to MA

54 $36.4 billion; Medicaid, $3.3 billion; other insurers, $9.6 billion; patients, $48.6 billion; and inc

55 testing if employers (93/117; 79.5%), health insurers (90/117; 76.9%), or life insurers (92/117; 78.6

56 %), health insurers (90/117; 76.9%), or life insurers (92/117; 78.6%) could access results.

57 of higher-cost products and diminish health insurers' ability to optimize pharmaceutical value.

58 ecords, changes in reporting requirements of insurers, advocacy on the part of patients, and incorpor

59 from an individual plan reenrolled with the insurer after 1 year, and 34% had reenrolled after 5 yea

60 ved from the largest German statutory health insurer, Allgemeine Ortskrankenkassen (AOK).

61 ncial burden that patients may experience if insurers allow waivers to expire, as many chose to do du

62 Health insurers alter the size of their networks, offering lowe

63 aims and administrative data from a national insurer and a pathways health care professional between

64 Data were limited to a single commercial insurer and did not capture nonbilled clinician-patient

65 patient payment, as that cost is set by the insurer and may depend on rebates from the manufacturer

66 administrative data of a private U.S. health insurer and performed a retrospective study of 4650 pers

67 Sentinel System (data from 2 national health insurers and 4 regional integrated health systems).

68 By using both in-person interviews with insurers and a direct market test, we found that a perso

69 Although insurers and agents are only vaguely aware of these laws

70 1 000 800 employees at private sector health insurers and brokers and 13 956 VHA Central Office perso

71 inatory use of genetic information by health insurers and employers.

72 The new law requires that insurers and health plans provide coverage for individua

73 icies that have stimulated profit-seeking by insurers and health-care providers.

74 The increasing involvement of insurers and hospitals in monitoring patient care is enc

75 ntives and coordinated care delivery between insurers and hospitals may help improve surgical outcome

76 cerns about the appropriateness and costs to insurers and patients of laboratory testing, this study

77 From the perspective of the insurers and patients, between 2009 and 2012, hospital-o

78 Ophthalmologists should work with insurers and pharmacists to prevent such discontinuation

79 rom failure to articulate to the public (and insurers and policymakers) what value it, and it alone,

80 In this market-driven system, insurers and providers compete not so much by increasing

81 and sharing of health care information among insurers and providers have been pursued.

82 U.S. insurers and providers spent $812 billion on administrat

83 France, that better balance the interests of insurers and research subjects, and explain how the Unit

84 ned detailed summaries of the cases from the insurers and reviewed the litigation files if the outcom

85 prevalent cancers, predominantly from large insurers and self-insured employers.

86 The fear of unwanted disclosure to insurers and the possibility of genetic discrimination c

87 The results should be of great interest to insurers and the research community as they consider per

88 ured through a large national private health insurer, and with 6 or more months of continuous enrollm

89 re providers, researchers, funding agencies, insurers, and engineers to actively work together in ful

90 Cancer advocates, insurers, and government agencies also have important ro

91 at it would be most meaningful to hospitals, insurers, and government agencies responsible for health

92 orldwide attention from professional groups, insurers, and governments.

93 ected and advocated by patients, clinicians, insurers, and health systems, others question their valu

94 of strategies affecting potential enrollees, insurers, and healthcare providers are offered.

95 Policymakers, insurers, and institutional review boards all have a rol

96 mptomatic genetic test results to employers, insurers, and others.

97 ers (general dental practitioners, patients, insurers, and policy makers) from the Netherlands, Germa

98 It is important that patients, physicians, insurers, and policymakers understand the relationship b

99 -additive spending, could help policymakers, insurers, and providers prioritize and design interventi

100 e improvements in coding, reimbursement from insurers, and research funding, and widespread education

101 ancial value to patients, public and private insurers, and society.

102 y of the insurance plans, risk adjustment of insurers, and solidarity.

103 Patients, hospitals, insurers, and the public rely on competent physicians.

104 ne public payer); free choice of provider or insurer; and expansion of services to poor people and th

105 mmunicate with risk managers, attorneys, and insurers; and finally, so that we can better understand

106 Insurers applying financial adjustments based on these a

107 was no evidence that manufacturer rebates to insurers are associated with patients' out-of-pocket spe

108 ancer clinical trials, although many private insurers are concerned about the expense of this effort.

109 Certain Florida-based insurers are denying patients access to bariatric surger

110 Many private insurers are following Medicare's lead.

111 Insurers are increasingly deploying "narrow networks" wi

112 Insurers are well positioned to participate in public-pr

113 considerable financial, ROIs to patients and insurers as they increase national wealth.

114 post-donation nephrectomy benefits with this insurer at some point from 2000 through 2007.

115 Although insurers bear the brunt of treatment costs for OA, the O

116 y share of well-child visits paid by private insurers before the mandate: mostly private (>66% of vis

117 ng strategies that involve financial risk to insurers can reduce budgeted health expenditures.

118 Malpractice insurers can use this information to guide malpractice r

119 , 2004 to December 31, 2010 using commercial insurer claims data.

120 Data were abstracted from a commercial insurer claims database in 12 states and analyzed from J

121 episodes), and hospital expenditures paid by insurers (commercial or governmental) during the 180-day

122 rtality and a net annual cost savings to the insurer compared with usual care processes.

123 A malpractice insurer convened a collaborative with 4 Harvard-affiliat

124 The third-party insurer cost perspective average cost-utility ratio was

125 spective is more likely than the third-party insurer cost perspective to demonstrate a greater financ

126 ective, which is the same as the third-party insurer cost perspective, includes the costs an insurer

127 was performed using societal and third-party insurer cost perspectives.

128 analysis using the societal and third-party insurer cost perspectives.

129 onal and ancillary services, suggesting that insurer cost-sharing waivers may not have covered all ho

130 Insurer coverage decisions for GH in specific case scena

131 NCCN) Compendium recommendations, a basis of insurer coverage policies.

132 For this hospital system in which private insurers covered 40% of patients (13,544), Medicare cove

133 kage with claim data from the largest health insurer covering 15% of the Swiss residential population

134 The third-party insurer CUR for bilateral ranibizumab therapy was $4587/

135 bursement of transplantation costs abroad by insurers; (d) ambivalence of the victim status of the se

136 Limited private insurer data also were obtained.

137 ween 2006 and 2009 linked to provincial drug insurer data on all drugs dispensed from community-based

138 ontrol group from a large national US health insurer database and included children initiating medica

139 on making and the interplay of physician and insurer decisions in determining access to care.

140 CIPANTS: This cross-sectional study used the insurer-disclosed Transparency in Coverage data as of Ma

141 Medicare and many commercial insurers do not cover US Food and Drug Administration-ap

142 ligible for 340B discounts retained 64.3% of insurer drug expenditures, whereas hospitals not eligibl

143 s can save over 35% from a public healthcare insurer drug formulary while maintaining or improving pa

144 tive to place higher-priced generic drugs on insurers' drug formularies to profit by creating a large

145 re almost no well-documented cases of health insurers either asking for or using presymptomatic genet

146 payments for surgical encounters paid by the insurer/employer and patient OOP expenses were calculate

147 alculated the administrative costs of health insurers, employers' health benefit programs, hospitals,

148 n and restricts access to medical records by insurers, employers, and clinical researchers.

149 through reimbursement restrictions by health insurers, especially for expensive cancer drugs.

150 into our everyday lives, even to inform how insurers evaluate our health.

151 eased OOP expenditures by $694 per annum and insurer expenditures by $4,036.

152 tures by $1,379 per annum (2007 dollars) and insurer expenditures by $4,833.

153 Of that amount, insurer expenditures were $149.4 billion and OOP expendi

154 In this cohort study, evidence that private insurers experience significant, sustained increases in

155 inimum direct cost that employers and health insurers face because not all people with SUDs have a di

156 s, and patients had been enrolled with their insurer for a mean of 30 months (95% CI, 29.9-30.1 month

157 nistrative claims data from a large national insurer for adult patients who received biologic infusio

158 m, new payment incentives implemented by one insurer for an accountable care organization (ACO) may a

159 ueried the claims database of a large health insurer for patients hospitalized for MI or with ATH.

160 ers of those surveyed reported pressure from insurers for early discharge; nearly two-thirds said hos

161 cated by government agencies and third-party insurers for the care of these individuals.

162 Among members who left the insurer from a group plan, 12% reenrolled after 1 year a

163 Fourteen percent of the members who left the insurer from an individual plan reenrolled with the insu

164 target indoor environmental exposures, most insurers generally have not covered the outreach, educat

165 period to determine whether the malpractice insurer had closed the case.

166 ere questioned about whether the hospital or insurers had pressured them to change their inpatient pr

167 Insurers have a vested interest because individually und

168 ending may be substantial for patients whose insurers have allowed waivers to expire.

169 Insurers have expressed concerns that these mandates wil

170 ional Medicare (TM), Medicare Advantage (MA) insurers have greater financial incentives to reduce the

171 Insurers have not routinely covered outpatient 18FDG-PET

172 Government and commercial health insurers have recently enacted policies to discourage no

173 however, is rationing these drugs, and other insurers have restricted coverage due to their exorbitan

174 Private insurers have similar provisions for children and adults

175 providers, patient advocates, agencies, and insurers have the responsibility and opportunity to prov

176 For all Medicare Advantage insurers, hematology and oncology drugs represented the

177 cancer community from physicians, patients, insurers, hospitals, and industry.

178 ors analyzed claims data from a large health insurer in New England.

179 data were drawn from a large private health insurer in North Carolina and analyzed from March 1, 200

180 inistrative claims data of a single national insurer in the US for 134 826 patients aged 18 to 63 yea

181 ministrative claims data of a large national insurer in the US linked to the Surveillance, Epidemiolo

182 udy used claims data from a large commercial insurer in the US to analyze changes in outcome measures

183 births and is the largest behavioral health insurer in the US, covering a robust array of services f

184 Commercial claims data from 3 large national insurers in the Health Care Cost Institute database were

185 paid by 3 of the 5 largest commercial health insurers in the United States (ie, Aetna, Humana, and Un

186 for Medicare & Medicaid Services) and other insurers in the United States depends on adherence.

187 years or younger covered by 3 of the largest insurers in the United States-United HealthCare, Aetna,

188 Calendar year 2002 claims data from 2 large insurers in Washington state were analyzed for provider

189 direct reimbursement, part of a strategy by insurers, including Medicare and private insurance compa

190 ble for approximately half of the largest US insurers, indicating need for greater transparency.

191 or mixed (33%-66% of visits paid by private insurers) insurance types.

192 ity measures at the clinician, hospital, and insurer level has created challenges and logistical prob

193 Evidence suggests insurers limit access to trials because of cost concerns

194 ssociated with a 2.3% reduction in available insurers (marginal effect size, -0.36 [0.17]; P = .04).

195 the largest MA insurers, suggesting that MA insurers may have variable ability to influence LVS redu

196 Among insurers, Medicaid stood out as a low and slow payer, bu

197 nment agencies, hospital and health systems, insurers, medical societies, health care quality consort

198 urer cost perspective, includes the costs an insurer might be expected to pay, including those for ph

199 stly private (>66% of visits paid by private insurers), mostly public (<33% of visits paid by private

200 medical claims data from a large national US insurer (N = 4,387,651).

201 Medicare, 14 states, and several private insurers now cover the costs of patient care in "qualify

202 Purpose Health insurers offer plans covering a narrow subset of provide

203 ed a mean (SD) of 3.18 (4.20) times QPA, and insurers offered 1.39 (3.89) times QPA.

204 Policy makers, employers, and insurers often provide financial incentives to encourage

205 Under reference pricing, the insurer or employer establishes a maximum contribution i

206 al of 636 trial participants from several US insurer or employer populations and an academic health s

207 e of those benefits or how much they cost MA insurers or enrollees.

208 e received requests from patients to deceive insurers (OR, 2.44; 95% CI, 1.72-3.45); (3) feel pressed

209 ostly public (<33% of visits paid by private insurers), or mixed (33%-66% of visits paid by private i

210 rcentage points was due to growth in private insurers' overhead, mostly because of high overhead in t

211 apita (17.0%) in Canada: $844 versus $146 on insurers' overhead; $933 versus $196 for hospital admini

212 patient annually, measured in terms of what insurers paid to the physician organizations for profess

213 s in total ($266; 95% CI, -$348 to $880) and insurer-paid ($308; 95% CI, -$352 to $968) expenditures

214 Insurer-paid costs were lower in the post-ACA period but

215 Many insurers participating in the new insurance exchanges ar

216 Changes in the way health insurers pay healthcare providers may not only directly

217 It is hoped that this overview will assist insurers/payors in reimbursing transplant centers for so

218 erage policy in April 2023, where the public insurer pays 100% of prescription costs.

219 minimizing costs because a third party (the insurer) pays the bill.

220 rs of drugs to retain a substantial share of insurer pharmaceutical expenditures.

221 g financial concentration in health systems, insurers, pharmacies, and benefit managers; (2) informat

222 was challenging given its ability to disrupt insurer-physician good-faith negotiations and thus impac

223 ises Act takes patients out of the middle of insurer-physician OON reimbursement disputes, limiting p

224 Most insurers, physicians, hospital administrators, legislato

225 Insurers, physicians, hospitals, and other providers fac

226 H therapy for children with Turner syndrome, insurer policies covered GH therapy for only 52% of thes

227 en used to justify traditionally restrictive insurer policies regarding clinical trials.

228 effectiveness to guide clinical practice and insurer policies.

229 Insurer price disclosure under federal Transparency in C

230 r clinical trials is often not reimbursed by insurers, primarily because of concern that medical care

231 tional representative surveys were mailed to insurers (private, Blue Cross/Blue Shield, health mainte

232 Private insurers ranked last (0.04% of revenue) and health syste

233 rivacy must be protected; public and private insurers rarely pay for electronic communication with pa

234 data indicated considerable variation among insurers regarding coverage policies for GH (P<.01).

235 Additionally, fear of insurer reimbursement denial can be a significant barrie

236 Yet, the financial costs to patients and insurers remain poorly understood.

237 were covered by Medicaid or other nonprivate insurers remained relatively steady throughout the study

238 tween 1985 and 2001 with a large malpractice insurer representing one third of the physicians in Mass

239 is of claims data from a large US commercial insurer, representing 347 356 patients who had undergone

240 Despite limited consensus, all insurers required PA extensively, particularly for physi

241 As health care systems and insurers respond to increasing opportunities to invest i

242 ect spending and quality of care for another insurer's enrollees served by the ACO.

243 he association between a national commercial insurer's ongoing pay-for-performance (P4P) program for

244 e providers may not only directly affect the insurer's patients but may also affect patients covered

245 ized patient-level claims data from 3 health insurers serving roughly 50% of insurees in Switzerland

246 are becoming available as public and private insurers shift reimbursement to reward better health out

247 Clinicians and insurers should consider 18FDG-PET/CT as a useful tool w

248 Clinicians should consider and insurers should cover 18F-FDG PET/CT when evaluating pat

249 tian, and other health professionals; health insurers should make these resources available to genera

250 Despite a widespread belief that private insurers spend large amounts on health care for enrollee

251 mmunity hospitals was associated with higher insurer spending for a surgical episode without differen

252 urce utilization, major coronary events, and insurer spending.

253 Health insurers, state regulators, and federal lawmakers should

254 rences existed across some of the largest MA insurers, suggesting that MA insurers may have variable

255 izes primary care physicians; and 4) private insurers tend to pay for procedures, but not for office

256 Insurers that provide these plans can exit Medicaid prog

257 ial hospital prices negotiated by 5 national insurers, the national means of minimum prices were 168%

258 It is incumbent on insurers, their regulators, and the policy community to

259 th insurance claims records of a New England insurer to assess the relation between salmeterol and se

260 to 2020 administrative data from a national insurer to compare prescription fills for beneficiaries

261 pport and participation of other health care insurers to adequately fund GME.

262 power increases because it is difficult for insurers to bargain successfully with one of only a few

263 ian groups, 15 488 physicians, and 35 health insurers to compare quality and health resource use for

264 losed malpractice claims from five liability insurers to determine whether a medical injury had occur

265 es are being used by an increasing number of insurers to ensure that medical care is provided by high

266 t these requirements, PLRs could incentivize insurers to expand access to expensive treatments by red

267 ing an ineffective therapy, PLR incentivizes insurers to increase patient access.

268 cting antivirals (DAAs) have led health-care insurers to limit access worldwide.

269 rect acting antivirals (DAAs) led healthcare insurers to limit access worldwide.

270 hat affect it is necessary for providers and insurers to optimize health outcomes for patients and sh

271 ance organizations won most cases, requiring insurers to pay more in these cases.

272 when the Affordable Care Act (ACA) required insurers to permit children to remain on parental polici

273 d programs have increasingly contracted with insurers to provide medical care services for enrollees

274 the financial risk of health care costs from insurers to providers, as has been done with the Medicar

275 CER is to empower the government and private insurers to reduce health care costs by restricting acce

276 h has prompted efforts by public and private insurers to steer patients toward the lower-priced optio

277 governments, financial institutions and (re)insurers to transfer the financial risk associated to th

278 Because insurers use performance and quality metrics to inform r

279 1, 28 states have enacted laws that prohibit insurers' use of genetic information in pricing, issuing

280 commercial prices across different national insurers varied substantially for the same hospital and

281 and differential payment rates by commercial insurers vs Medicare.

282 Many insurers waived cost sharing for COVID-19 hospitalizatio

283 percent; the overhead among Canada's private insurers was higher than that in the United States (13.2

284 encounter data from a national United States insurer, we identified patients <65 years old with an in

285 Using data from malpractice insurers, we analyzed the claims experience of chiroprac

286 ,207 patient datasets of a German healthcare insurer were screened.

287 Insurers were asked coverage decisions for GH therapy.

288 tiated with pharmacies and the price paid by insurers (what is known as spread pricing).

289 n was defined by the standard method used by insurers, which is a hospital stay that exceeds the Diag

290 In addition, government-based and private insurers will be expecting documentation of the paramete

291 grams being introduced by Medicare and other insurers will link provider revenues to quality indicato

292 ss, these laws have made it less likely that insurers will use genetic information in the future.

293 re covered by a large professional liability insurer with a nationwide client base (40,916 physicians

294 pitals, suggesting that most were covered by insurers with cost-sharing waivers.

295 work created by having to deal with multiple insurers with different rules, often designed to avoid p

296 ietal gain was $28.5 billion to patients and insurers, with $24.2 billion (84.9%) coming from bevaciz

297 s and has been covered by public and private insurers without cost sharing since 2015.

298 Insurers would also tailor benefit packages and develop

299 children with idiopathic short stature, but insurers would not cover GH for the vast majority of the

300 Health insurers would respond to the demands of individual cons