Go to AllMed Homepage
	Special Offer
	Download PDF Case Study for Capital BlueCross
	Download Additional Case Studies

Medical Review News
Stay on top of the latest medical claims review practices, trends and legislation. If you haven't already signed up, please do so below.

First Name:
Last Name:
Company:
Email:

AllMed Newsletter | Vol. 2, 2004

Welcome to the latest edition of AllMed's Medical Review News, the e-newsletter for medical directors, claims and case management professionals, and insurance payers and providers. We hope you'll find this information useful. We encourage you to sign up today to receive future issues. Comments are always welcome at info@AllMedmd.com.

Medical Director's Update
by Skip Freedman, MD
Medical Director
AllMed Healthcare Management

Dear Readers,

Obesity has reached a crisis level in this country, with obesity registering at 30 percent of the population. Gastric bypass surgery is generally considered to be the best surgical procedure for the treatment of morbid obesity. In fact, doctors are expected to perform 140,000 bariatric surgeries in 2004 alone.

MORE >>

When Is Eyelid Surgery Medically Necessary?

Last year almost 250,000 people in the United States underwent eyelid surgery, or blepharoplasty. Because aging causes the skin around the eye to sag, blepharoplasty has risen to become one of the most sought-after plastic surgery procedures for patients over the age of 35. The extremely thin skin making up the eyelids starts to lose its elasticity and stretch, and it's largely a hereditary condition. If your siblings and parents have saggy eyelids, you probably do as well.

MORE >>

Hospital Stays - When to Pay for the Last Day

When a patient is admitted to the hospital, the most expensive days are the first few. These are the days when the patient is the sickest and the hospital staff is running tests and doing workups trying to sort out the patient's condition. After that, the diagnostic intensity usually slows down. The hospital staff shifts to treatment mode and the patient starts to improve. Eventually the patient is discharged.

So when does it make sense for the patient to go home? When should the last day be denied or approved?

MORE >>

Making ERISA and DOL Appeals Easier and More Cost-Effective

According to the rules established by the Department of Labor and the Employee Retirement Income Security Act (ERISA), every employee benefit plan is required to "establish and maintain a procedure by which a claimant shall have a reasonable opportunity to appeal an adverse benefit determination [a denial] to an appropriate named fiduciary of the plan, and under which there will be a full and fair review of the claim and the adverse benefit determination." Furthermore, an employee benefit plan must also provide claimants a review that does not "afford deference to the initial adverse benefit determination and that is conducted by an appropriate named fiduciary of the plan who is neither the individual who made the adverse benefit determination that is subject of the appeal, nor the subordinate of such individual."

MORE >>

Customer Spotlight: Capital BlueCross
"Using Peers to Ensure Quality and Necessity"
View a more detailed PDF case study from our webpage

MORE >>

© 2004 AllMed Healthcare Management. All rights reserved.