Aetna Case Study

Unfortunately, Aetna’s compliance with the implant carve-out over the past five years has been anything but straightforward. By 2011, Aetna began to deny additional payment for charges billed using revenue code 278, despite its contractual obligations to pay the Hospitals for other implants billed using that revenue code. Instead, Aetna appears to be relying on an internal policy it has promulgated in an effort to unilaterally reduce its payment obligation for “Other Implants.” This internal policy, which is called the “Implants and Supplies Policy” (the “Implant Policy”), attempts to limit the implant carve-out payment to what the Implant Policy refers to as “Implantable Devices.” The term “Implantable Devices” is define by Aetna

In terms of the Fitbit marketing strategy, in the past year the products have become more personalized with various wrist bands, watch faces, and styles for their consumers to choose from. Fitbit has added more character to their products in hopes of fighting off their competitors, such as Apple. A plethora of competitors are becoming increasingly popular and are approaching Fitbit. The consumer perception when it comes to the various appearances that Fitbit has recently introduced may increase because of the efforts the brand puts into

With Aetna HMO, a Primary Care Physician (PCP) gives fundamental social insurance benefits and organizes particular administrations when required. You can pick any PCP from the Aetna network. You will feel great realizing that anybody you pick meets our theirs standards. Picking a doctor is an individual choice, that is the reason every individual from your family can have his or her own particular PCP. You can change your PCP whenever need be. You should pick a PCP and see providers in the network to receive benefits from this plan. When you visit your PCP or a specialist, you will have to pay a copay fee.

I believe that the current supply of labor had much to do with the arousal of this decision. I also think that seeing other corporations take the initiative to try another way of building a connection with the employees of the company also urged Aetna to make this decision.

The Basic Health program could be structure in several ways. It could expand programs such as Medicaid and CHIP and contract with managed care plans on behalf of its Medicaid and CHIP beneficiaries outside the private insurance market. These changes would allow both programs to continue as a "separate program with a separate financing mechanism and risk pool from that of Medicaid and CHIP, but would leverage the state's existing infrastructure for information technology, contracting, rate setting, and other function" (Angeles, 2012). Alternatively, a state could expand the Medicaid managed care by increasing the number and types of service through different network of providers, other than those that serve Medicaid and CHIP beneficiaries (Angeles,

Aetna’s customized iTriage app helps employers make better health care decisions based on appropriateness and affordability of care. Aetna launched this customizable app to allow customization of information for consumers based on their specific health benefits plan. It helps employers to understand how using an in-network health care provider can be more affordable, which can also be used to create cost savings for employers and reduce administrative work for health care providers, who will benefit from informed patients, who have selected the right physician, facility and level of care based on their individual needs. The iTriage app is Aetna’s vision of creating a better healthcare experience for their customers and their employers (Aetna,

On Jan. 1, 2014, the Affordable Care Act (ACA) added substance abuse and mental health care to the list of essential health benefits; therefore, all small business and individual plans are required to offer coverage for these conditions.

Members also gain access to registered nurses on a 24 hour basis through a toll free phone line and can ask questions related to health and wellness, states Aetna. Members have better means to monitor and control their blood pressure using the blood-pressure cuff and support for free. Being a Medicare advantage plan, it offers part C medical coverage. This means a member gains access to both part A and Part B cover ages in one plan. It covers wellness, dental, hearing and vision services.

According to a study conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), in any given year approximately 14 percent of adults in the U.S. misuse alcohol. George Koob is the Director of the NIAAA, he states that the risk of suffering with an alcohol use disorder (AUD) has been on the rise for the last 10 years.

The new affordable healthcare reform has been delayed until 2015/2016. This mandate requires employers with 50 or more full time employees to provide health insurance or pay a per month "Employer Shared Responsibility Payment" on their federal tax return (Pyne, 2013). This has employers concerned about continued increases in healthcare cost. This cost increase provides an incentive to create new innovative solutions toward healthcare services. One solution that has been gaining traction is the use of preventive care. Preventive care involves a healthy lifestyle from nutrition, exercise and frequent visit to healthcare facilities for health monitoring. Monitoring provides the means to identify issues early so that less costly health services will be required to resolve.

A psychologist who counsels a patient and also give expert testimony on behalf of the client involves understanding the legal principle regarding expert witness. APA Ehtics provided guidelines that governs the role of a forensic psychologist. This paper looks into the details of what it means to be an expert witness for the plaintiff.

Josh Sutter and his wife Elizabeth call to enroll in a Medicare Advantage plan. They have just lost employer coverage with Elizabeth’s job since she just turned 65 and has retired. Agent Nancy Prigge verifies HIPAA compliantly with both Josh and Elizabeth, who are on speaker phone. Nancy goes on to ask for the couple’s PCP. Josh states he sees Dr. Kristina Anderson and Elizabeth states she’s a patient of Dr. Dennis Patton.

Blue Shield is a private insurance broker in California and they were billed four hundred and eight dollars by Torrance Memorial Medical Center and apart from the insurance claim the patient had to pay nearly three hundred dollars for their medical expense. The patient enquired about this expense to the insurer and they said that the cost for a simple blood test was charged around eighty dollars, the patient cross verified the information with the billing department of the hospital and was informed that they would have paid less if they had no insurance plan. But the actual cost for a simple blood test was only around fifteen dollars.

An AbbVie core competency starts with adaptability which is to maintain effectiveness in different environment and with different tasks and responsibilities. While the second competency is collaboration: where all should work effectively with team or work group even those existing outside formal line of authority in order to accomplish organisational goals. Other competencies are innovation (which is the main tool to generate creative solutions), integrity (to build a trust), customer focus and ending with planning and organizing.