Success unclear for long-term-care plan experiment

Article Abstract:

The Robert Wood Johnson Foundation manages the Partnership for Long-Term Care, a program designed to save Medicaid funds and reduce the financial burden of paying for long-term care. Patients typically must either spend-down or divest their assets before Medicaid will pay for long-term care. The partnership offers an insurance policy to protect the patient's assets while guaranteeing Medicaid coverage.

Finance, Statistics, Medicaid, Long-term care of the sick, Long term care, Long-term care insurance, Long term care insurance, Robert Wood Johnson Foundation

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AMA sends second notice on Aetna contract concerns

Article Abstract:

The American Medical Association has sent a second request to Aetna US Healthcare to alter its physician contracts. AMA officials contend the contracts interfere with medical decision making by allowing Aetna to override a doctor's judgment on which services are medically necessary. The contracts also contain no appeal process for doctors to challenge coverage denials.

American Medical Association, Health insurance industry, Aetna U.S. Healthcare Inc.

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Contracts need clarity and accountability

Article Abstract:

Managed care contracts should spell out specifically what services and treatments are covered to avoid legal repercussions from physicians and patients. The primary complaint in lawsuits pending against managed care firms target decisions the firms made regarding coverage. The language in many current contracts allows for a wide variety of interpretations.

Column, Managed care plans (Medical care)

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