处理医疗保险优势计划的营销行为。

IF 2.4 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Forrest Bohler, Eli Y Adashi
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引用次数: 0

摘要

医疗保险优势计划(MA)拥有近一半的符合条件的医疗保险人口,最近受到了越来越多的关注。美国参议院财政委员会和医疗保险与医疗补助服务中心(CMS)最近进行的调查发现,医疗保险代理人的营销行为 "不符合现行规定,对受益人施加不当压力,并且未能提供准确或足够的信息,帮助受益人做出知情的注册决定"。这些发现正值医疗保险计划因拒绝符合医疗保险承保医疗服务指南的事先授权请求而受到调查之际。在本评论中,我们将探讨医疗保险计划受到越来越严格审查的背景及其对其未来发展轨迹的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Addressing the Marketing Practices of Medicare Advantage Plans.

The Medicare Advantage (MA) Program, home to nearly half of the eligible Medicare population, has recently come under increased scrutiny. Recent investigations conducted by the United States Senate Committee on Finance and Centers for Medicare & Medicaid Services (CMS) have uncovered marketing practices of MA insurance agents that "were not complying with current regulation and unduly pressuring beneficiaries, as well as failing to provide accurate or enough information to assist a beneficiary in making an informed enrollment decision." These findings come at a time in which MA programs are under investigation for denials of prior authorization requests that fall within Medicare guidelines for covered health services. In this Commentary we consider the backdrop for the growing scrutiny of the MA program and the implications thereof to its future trajectory.

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来源期刊
CiteScore
4.90
自引率
6.90%
发文量
168
审稿时长
4-8 weeks
期刊介绍: Published since 1988, the Journal of the American Board of Family Medicine ( JABFM ) is the official peer-reviewed journal of the American Board of Family Medicine (ABFM). Believing that the public and scientific communities are best served by open access to information, JABFM makes its articles available free of charge and without registration at www.jabfm.org. JABFM is indexed by Medline, Index Medicus, and other services.
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