{"title":"HMOs: where are the savings?","authors":"E K Cooney","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>HMOs may yet become an important means for effecting health care savings. But to attain that goal, they must confront the challenges facing them--such as regulatory restrictions and intense competition.</p>","PeriodicalId":79803,"journal":{"name":"Best's review. Life-health insurance edition","volume":"87 6","pages":"26-32, 136"},"PeriodicalIF":0.0,"publicationDate":"1986-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21145976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The future of small group health.","authors":"J D Miller","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79803,"journal":{"name":"Best's review. Life-health insurance edition","volume":"87 5","pages":"28-34"},"PeriodicalIF":0.0,"publicationDate":"1986-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21181949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Residential facility is \"hospital\" in group medical policy dispute.","authors":"C Wasilewski","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A residential facility that treated preadolescent children suffering from functional nervous disorders was considered to be a \"hospital\" for purposes of coverage under a group medical insurance policy, despite the fact that it lacked an on-premises surgical facility and did not provide 24-hour nursing services by registered nurses. The insurance company had waived the surgical facility requirement. Additionally, since the policy in question did not contain a definition of \"nursing services,\" there was no requirement that these services be provided 24 hours a day by registered nurses. Thus the insureds were entitled to coverage of the treatment for their son in the residential facility. But a bad faith claim was denied because the insurer's interpretation of its policy was not found to be unreasonable.</p>","PeriodicalId":79803,"journal":{"name":"Best's review. Life-health insurance edition","volume":"87 5","pages":"140-2"},"PeriodicalIF":0.0,"publicationDate":"1986-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21181948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Expect the unexpected.","authors":"N L Nielson, M V Gonzalez","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79803,"journal":{"name":"Best's review. Life-health insurance edition","volume":"87 2","pages":"36-42, 120-2"},"PeriodicalIF":0.0,"publicationDate":"1986-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21169957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Split rates: who benefits?","authors":"K T La Pensee","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79803,"journal":{"name":"Best's review. Life-health insurance edition","volume":"86 12","pages":"50-4, 122"},"PeriodicalIF":0.0,"publicationDate":"1986-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21143224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A profit in need of discovery.","authors":"C A Cardinal","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79803,"journal":{"name":"Best's review. Life-health insurance edition","volume":"86 12","pages":"58-60, 128-9"},"PeriodicalIF":0.0,"publicationDate":"1986-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21143225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical evaluation: the next step in claims processing.","authors":"R P Bernier","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79803,"journal":{"name":"Best's review. Life-health insurance edition","volume":"86 12","pages":"106-10, 127"},"PeriodicalIF":0.0,"publicationDate":"1986-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21148382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Don't rule out the little guy.","authors":"R Aller","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79803,"journal":{"name":"Best's review. Life-health insurance edition","volume":"86 12","pages":"21-2, 24"},"PeriodicalIF":0.0,"publicationDate":"1986-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21143221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}