Tag Archives: payers

Reimbursement Report

A Major National Health Plan Medical Director Shares Insights on How Coverage Decisions are Made

By Jessica Holmes
No Comments

This Q&A session, with an active Regional Medical Director involved in traditional health plan policy and payment development, as well as emerging value-based models, reveals important information and attitudes toward coverage of new/existing technologies and standards of evidence.

This Q&A session, with an active Regional Medical Director involved in traditional health plan policy and payment development, as well as emerging value-based models, reveals important information and attitudes toward coverage of new/existing technologies and standards of evidence.

Continue reading

Reimbursement Report

The Appeals Process

By Elizabeth Brown, MD
No Comments

Presenting clinical evidence to payers is the most efficient method of gaining coverage. But when this strategy is unsuccessful or hits a wall, a ground-up approach is required, relying on consistent and steady support from local physician champions that demonstrates broad acceptance of a technology.

Presenting clinical evidence to payers is the most efficient method of gaining coverage. But when this strategy is unsuccessful or hits a wall, a ground-up approach is required, relying on consistent and steady support from local physician champions that demonstrates broad acceptance of a technology.

Continue reading