Medical Review Companies Role in Your Insurance Claims – Your Health, Coverage, and Guarantee

A medical review company supplies more than a second opinion. The unbiased nature of a medical review company is critical not only to the bottom dollar, but to the final result. Too often, patients think they are just numbers in a file or bits of information in a computer program. The maligned image of an insurance company’s automatic denial of claims without really understanding the patient’s need contributes consumer dissatisfaction and frustration.

What Does It Have to Do With You?

Patients are people and when they need healthcare, they don’t want to read the fine print or a medical dictionary, they just want their claims covered. Most often, it’s unlikely they would realize that their insurance claim went through an Insurance Review Organization’s medical insurance review process. In fact, they probably just fill out the forms, hand a receptionist their insurance card and sign on the necessary release forms.

One of the most common complaints about needing healthcare is the cost followed closely by the complications of paperwork generated through authorization forms, claim forms and more. An insurance review organization is an intermediary company that insurance companies may outsource their claims to in order to determine with medical and insurance coverage accuracy the validity of a claim filed by someone insured by their company.

Your Health Matters

Insurance companies who deny a claim are often portrayed as heartless or more interested in the bottom dollar than they are about showing compassion. This perception is only augmented when an insurance company rejects a claim for anecdotal evidence. When a claim goes through a medical review company’s insurance review process – it will not be rejected or denied based on anecdotal evidence.

For example, a patient suffers from shoulder, back and neck pain as well as bra strap grooving and eczema. Her medical history indicates years of chiropractic treatment as well as advice for non-steroidal anti-inflammatory drugs (i.e. Tylenol, Advil) and worn specialized support bras to support a 34DD frame and all of it to no success. Excessively large breasts can cause many of the symptoms the woman’s medical history indicated.

The doctor recommended a breast reduction procedure to alleviate the problem and the symptoms.

Your Coverage Matters

When the claim is submitted to the insurance company, the policy may not cover elective cosmetic procedures. Many policies do not. Claim managers lacking medical expertise will often compare a procedure request against a list of approved procedures. If cosmetic procedures are not covered, it is likely the claim will be denied. The patient is left either choosing to pay for the procedure out of pocket or continuing to suffer.

If the claim is submitted to a third party intermediary such as a medical review company, the answer will be different. The medical review company has access to a large number of medical specialist and insurance experts. The medical specialists will review the patient’s medical history and the doctor’s recommendations. When her file is reviewed, the third-party specialist will take into account the history of shoulder, neck and back pain. They will note the visits to a chiropractor and other pertinent symptoms.

If the medical specialist agrees with the patient’s physician that she is suffering from Macromastia (excessively large breasts), then he or she will understand that the cosmetic surgery of breast reduction provides the patient with the best option for the patient’s relief.

Confidence Matters

The review process may be transparent to patients whose insurance company uses a medical review company; but the effect is profound. Their coverage premiums will likely be lower. Their medical needs will be addressed. They will not see their healthcare costs rise due to the underwriting of unnecessary procedures. When it comes right down to it, a medical review company gives patients confidence that both their medical and insurance needs will be met. They won’t have to suffer misery unnecessarily nor face collections over mounting debt.

Your Ultimate Guide to Health and Fitness

Health and fitness is perhaps the most talked about thing today. It has now become an important thing to attain and the sad part is that it is not integrated into normal course of activity. If you want to see the best results, you have got to make sure that these efforts to gain health and be fit, need to be woven into normal daily activities; it no longer should be only kept to the gym or say a yoga class or the dieticians’ cabin. Realize that health is a state of being; you cannot disunite with your course of routine. So if you have understood the need to be healthy and fit, you could read on, because this is your ultimate guide to health and fitness.

To make sure that you are healthy and fit, you have got to take into account two important aspects; food and exercise. Food is something that ensures your state of mind and exercise makes you fit and healthy.

Food: Food is an essential criterion for health. Through food, you can be sure of achieving a high state of health. Here are a few tips

· Eat mainly plants. Meat becomes stale in your body and can lead to many unwanted health complications. Also plants keep you fit and active throughout.

· Eat regularly, and do not skip any meal. The key is to eat light and also to increase the number of meals and reduce quantity. Remember that you alter your diet, not to lose weight, but to remain healthy. Follow the very famous adage ‘Breakfast like a King, Lunch like a Prince and Dinner like a pauper’.

· Avoid packaged food, caffeine, soft drinks, etc. these play havoc within the system. To avoid it perhaps is a hard thing to do, but you can keep them all for one or two days in a week.

Exercise: Exercise is also another important thing to make sure that you are fit. Being fit is being physically fit. This state can be certainly achieved by proper food and a good dose of exercise. Remember that, exercise is the most important thing and goes hand in hand with the food. Exercise is necessary on a daily basis, or maybe you can give yourself a break on one day of the week.

· Make it a point to exercise. Either visit the gym, or go swimming or decide to take a walk or just get down to do some stretches. The key is, you have to exercise adequately to make sure that you are fit.

Online Dating Tips for Men

When online dating first came on the scene, it was taboo to discuss and if you ever met someone you would tell everyone you met them in some type of socially acceptable location. Today, it has become a prime location for meeting more girls than you ever could at a bar, club, or wherever your hunting ground may be. As with regular dating, it’s much easier for women than men. Women never have to initiate contact, never have to set up dates, and never have to really try. Hopefully these top online dating tips for men will make it as easy for you as it is for them.

Online Dating Tips for Men: Creating Your Web Presence

Use Online Dating as Practice: With so many women on sites like Match, OKCupid, and PlentyofFish, it wouldn’t make sense for any guy to not have a presence online. At the same time, you don’t want this to become your lone source for meeting girls. You want to use the experience to improve your dating skills – conversing, flirting, creating attraction and sexual energy, and escalating. The actual service itself, however, is only good for meeting girls in real life. You don’t want a pen pal so don’t spend a lot of time on the site. Try to get a date as quickly as possible.

Building an Attractive Profile: All of these services boast their fancy algorithms and tests that match you based on personality. Whoop dee do. Few people care about anything but the photos. Your photos are the most important part of your profile and should portray you in the most positive and attractive light. While men have a fairly basic 1-10 scale for rating female attractiveness, women have a different scale for guys. You don’t need to look like Brad Pitt to be an attractive man.

Your profile should a) show that you are a well groomed and well dressed guy, b) show you in fun situations, preferably with other people, c) show girls a sense of what it would be like to date you. In many cases, the setting and circumstances in a photo are more important than what you actually look like. And for the love of all that is holy, please no shots of your abs.

Building a Confident Profile: There is nothing sadder than a guy being self defacing or putting himself down in his own profile. This is where you need to present your absolute best self, not give women a reason to dismiss you. Never write anything that speaks negatively to your looks, personality, financial situation, or anything else. If a girl isn’t into you for one of those reasons, that’s her problem. You are here to meet girls, not give them a reason to move on to the next guy.

Online Dating Tips for Men: Getting The Girl

Avoiding Lame Responses: You are so much less likely to get a response if you send a message like “Ur cute, what’s up?” or “Yo you’re hot, lets hook up” than a real message. Avoid physical compliments, bring up a detail from their photos or profile and start flirting. It’s perfectly fine to poke fun at them or inject some sexual humor or innuendo.

Once you are talking, take it offline by saying something like “I spend enough time online as it is, let’s talk over a drink” or at least move it off the website and start texting or talking on the phone. Different girls wait different amounts of time, you don’t need to get stuck on girls that want to wait forever to meet or may not want to meet at all.

Set Up Dates ASAP: First, chatting online is an incredibly lame experience, like we said, we aren’t looking for a pen pal. Second, the initial contact is when the attraction is strongest so you want to build off that momentum instead of letting her find a reason to not meet you based on some off handed message. Third, a lot of the girls on these sites, especially the free sites, don’t want to meet anyone so you don’t want to spend all that time trying to build attraction with a girl who never had any intentions of meeting you. Most importantly, dating and attraction is something that is completely different in person than online, make the experience as real as possible for both of you.

Texting and Phone Game: Usually when you ask a girl out you will exchange numbers. Some girls prefer to text or talk on the phone before they meet you. That’s fine, just remember that the goal is still to set the date up as quickly as possible and turn your online dating encounter into real dating.

First Date: An online first date is different from a real first date because it’s the first time you are actually meeting. It’s best to avoid high pressure dates like fancy dinners so go for something more low key. Some guys prefer to talk and get to know her, a simple drink or even a coffee date is fine for a first encounter. Some guys prefer to not have too much one-on-one pressure so taking her to a show, movie, or party may be the best way to go. Once you’ve met and built some comfort and hopefully attraction, you can move on in your usual way.

The Different Dating Sites

Not all dating sites are created equal and there are major differences between them. Let’s take a look at the biggest ones.

Match.com: This is a pay site which is both good and bad. You don’t need to spend money on online dating but consider this: the women on this site are paying to have Match.com help them find someone. They are actually investing in this meaning they are more serious about dating than a girl on a free site who may have made a profile on a whim or just to boost that ego.

OKCupid: As far as free dating sites go, OKCupid is definitely a great one. This site tends to have a younger demographic with many girls in college or recently graduated. The scene also leans to the artsy side with a lot of aspiring designers, artists, musicians, writers, etc. This site seems to offer a higher response rate than others but also has a ton of girls that don’t have any real interest in dating.

PlentyofFish: A free site with tons of profiles and probably has the largest percentage of girls who are willing to meet up. Free sites are probably the best way to put these online First date tips for men into practice without any real investment except time.