health insrance already claimed
hins87
wk7_draft.docxYour responses should be 1-2 paragraphs in length for each question.
1. Mrs. Harlan is the wife of an active duty service member who is enrolled in TRICARE Standard. She has battled postpartum depression since the birth of her second child, two months earlier, and has decided to seek the services of a mental health professional. What procedure must she follow for these services to be covered by TRICARE Standard?
2. You have been working for a physician in private practice for 8 months. You start to see a pattern with several of his workers’ compensation cases. Each of these patients seems to have more tests and procedures ordered than others with similar conditions. One day the physician asks you to complete and send a billing claim to the insurance carrier for a procedure that you do not think he performed. What are your responsibilities, and what would you do?
3. Von, a patient of the physician who employs you, has chronic medical conditions including vascular insufficiency in his lower extremities and cervical neck pain from mild osteoarthritis. He was injured at work when the elevator in which he was riding suddenly dropped two floors. He has come to see the physician for treatment and asks to have his medical bills sent to his employer. What is your response?
4. What elements are typically required in a physician’s medical report to process a disability income insurance claim?
After reading the LIRN article below, which was also included in the Module 7 Lecture Notes, please answer each of the following questions. Each question should have a 2 to 3 paragraph response. Remember to support your work with APA references and in-text citations. Please visit the Academic Resource Center for concise APA guidelines.
Piechowski, Lisa D. "Disability and Workers' Compensation Claims, Assessment of." Encyclopedia of Psychology & Law. Ed. Brian L. Cutler. Vol. 1. Thousand Oaks, CA: SAGE Publications, 2008. 222-224. Gale Virtual Reference Library. Web. 19 May 2014.
1. Sources of disability benefits include: private disability insurance policies, public and private sector employee benefits, and federal entitlement programs (Social Security Disability). Describe in detail the benefits of each and how each are subject to different federal, state, and local laws.
2. Mental health claims are particularly difficult to adjudicate as they are based on subjective symptoms. In the assessment of disability claims, the key issue is functionality; specifically, has the claimant's ability to function in his or her occupation been impaired? Thus, three questions must be addressed: (1) Does the claimant have a psychiatric condition? (2) Are there functional impairments related to this condition? (3) Do these functional impairments affect work capacity?
3. In the workers' compensation system, independent evaluations are referred to as qualified medical examinations (QMEs). What sources are included when assessing disability or worker’s compensation claimants? What should be included in the QME report? Expand on each section as necessary.
