Health Insurance Sourcebook: Basic Information about Managed Care Organizations, Traditional Fee-for-Service Insurance and More / Edition 1

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Editorial Reviews

Doody's Review Service
Reviewer: Alice T. Longman, EdD, RN, FAAN (University of Arizona College of Nursing)
Description: This book, part of Omnigraphics Health Reference Series, is designed to assist general readers to understand the various forms of health insurance. The book is divided into seven parts, which focus on broad areas of interest such as managed care, Medicare, and Medicaid.
Purpose: The purpose is to offer information and explanations about various types of health insurance, including fee-for-service plans, health maintenance organizations, preferred provider organizations, Medicare and Medicaid, non-cancelable policies, third-party payers, and preexisting condition clauses. Explanations are given in relation to special populations that include retirees, elderly, children, veterans, new citizens, and illegal aliens.
Audience: The topics addressed in this book should be useful for a variety of health professionals as well as the lay public. The explanations of each type of health insurance could be useful for office personnel and nurse practitioners to answer patients' concerns and questions about healthcare coverage. The layout of the book is particularly helpful as it provides easy access to reference material.
Features: There are several very useful features of this book. In particular, the tables are well done and include data from U.S. government agencies and the National Conference of State Legislatures. The figures are clear and serve to enhance the material in the text. There is, however, a scarcity of references other than those from U.S. Government agencies. The table of contents is well done and affords the reader access to topics. Other features include glossaries and definitions of important terms.
Assessment: This book is a most useful addition to the vast amount of information about health insurance. It is broken into seven parts, so the book is accessible to readers interested in a single issue. The use of data from U.S. government agencies is most commendable. Since the book is primarily a reference, it would be useful in a library or learning center for healthcare professional students.
Alice T. Longman
This book, part of Omnigraphics Health Reference Series, is designed to assist general readers to understand the various forms of health insurance. The book is divided into seven parts, which focus on broad areas of interest such as managed care, Medicare, and Medicaid. The purpose is to offer information and explanations about various types of health insurance, including fee-for-service plans, health maintenance organizations, preferred provider organizations, Medicare and Medicaid, non-cancelable policies, third-party payers, and preexisting condition clauses. Explanations are given in relation to special populations that include retirees, elderly, children, veterans, new citizens, and illegal aliens. The topics addressed in this book should be useful for a variety of health professionals as well as the lay public. The explanations of each type of health insurance could be useful for office personnel and nurse practitioners to answer patients' concerns and questions about healthcare coverage. The layout of the book is particularly helpful as it provides easy access to reference material. There are several very useful features of this book. In particular, the tables are well done and include data from U.S. government agencies and the National Conference of State Legislatures. The figures are clear and serve to enhance the material in the text. There is, however, a scarcity of references other than those from U.S. Government agencies. The table of contents is well done and affords the reader access to topics. Other features include glossaries and definitions of important terms. This book is a most useful addition to the vast amount of information about health insurance. It is brokeninto seven parts, so the book is accessible to readers interested in a single issue. The use of data from U.S. government agencies is most commendable. Since the book is primarily a reference, it would be useful in a library or learning center for healthcare professional students.
Booknews
A collection of 44 articles from government agencies and professional organizations to help lay readers understand the many types of health insurance and make wiser decisions when providing insurance for themselves and their families. They cover general information, disability insurance, managed care, Medicare and Medicaid and fraud in those programs, military and veterans' insurance, and health insurance for special populations. The articles vary widely in format. Most lack bibliographies, and all lack cross-referencing. Annotation c. by Book News, Inc., Portland, Or.

3 Stars from Doody
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Product Details

  • ISBN-13: 9780780802223
  • Publisher: Omnigraphics, Incorporated
  • Publication date: 1/1/1997
  • Series: Health Reference Series
  • Edition number: 1
  • Pages: 530
  • Product dimensions: 6.21 (w) x 9.30 (h) x 1.55 (d)

Table of Contents

Preface
Ch. 1 Checkup on Health Insurance Choices 3
Ch. 2 Two-Worker Families: Choice of Health Insurance 19
Ch. 3 No Insurance, Public Insurance and Private Insurance: Do These Options Contribute to Differences in General Health? 23
Ch. 4 Private Health Insurance: Persons Denied Coverage Due to Poor Health 31
Ch. 5 Does Employment-Related Health Insurance Inhibit Job Mobility? 35
Ch. 6 Effect of Employment-Related Health Insurance on Job Mobility, 1987: Does "Job Lock" Exist? 39
Ch. 7 Viatical Settlements: A Guide for People with Terminal Illnesses 43
Ch. 8 Health Insurance Coverage of People with Disabilities in the U.S. 51
Ch. 9 Reviewing Your Disability 55
Ch. 10 Disability Based on Drug Addiction or Alcoholism 59
Ch. 11 Social Security: Federal Disability Programs Face Major Issues 63
Ch. 12 Supplemental Security Income: Disability Program Vulnerable to Applicant Fraud When Middlemen Are Used 75
Ch. 13 What Legislators Need to Know about Managed Care 91
Ch. 14 Managed Care and Rural America 131
Ch. 15 Managed Care: Jekyll or Hyde? 137
Ch. 16 Your Medicare Handbook 1996 145
Ch. 17 Retirees: Medicaid and Other Public Health Insurance Coverage 183
Ch. 18 Medicare: Federal Efforts to Enhance Patient Quality of Care 185
Ch. 19 Medicaid: Spending Pressures Spur States toward Program Restructuring 189
Ch. 20 Medicare Managed Care: Growing Enrollment Adds Urgency to Fixing HMO Payment Problem 195
Ch. 21 Medicare Beneficiaries: Use and Cost of Prescribed Medicines 207
Ch. 22 Fraud and Abuse: Medicare Continues to be Vulnerable to Exploitation by Unscrupulous Providers 213
Ch. 23 Fraud and Abuse: Providers Target Medicare Patients in Nursing Facilities 225
Ch. 24 Special Fraud Alert: Routine Waiver of Copayments or Deductibles Under Medicare Part B 235
Ch. 25 Medicare Excessive Payments for Medical Supplies Continue Despite Improvements 241
Ch. 26 Questionable Practices Affecting the Hospice Benefit 253
Ch. 27 Medicare: Millions Can Be Saved by Screening Claims for Overused Services 259
Ch. 28 Medicare Spending: Modern Management Strategies Needed to Curb Billions in Unnecessary Payments 265
Ch. 29 Medicare Providers' Legal Expenses 281
Ch. 30 U.S. Department of Health and Human Services Reports Promising First Year for "Operation Restore Trust" Initiative 287
Ch. 31 Defense Health Care: Issues and Challenges Confronting Military Medicine 299
Ch. 32 Defense Health Care: Department of Defense's Managed Care Program Continues to Face Challenges 333
Ch. 33 Defense Health Care: Problems with Medical Care Overseas Are Being Addressed 341
Ch. 34 Veterans Administration Health Care: Challenges and Options for the Future 355
Ch. 35 Veterans' Health Care: Use of Veterans Administration Services by Medicare-Eligible Veterans 373
Ch. 36 Presidential Advisory Committee on Gulf War Veterans' Illnesses: Interim Report 383
Ch. 37 Operation Desert Storm: Health Concerns of Selected Indiana Persian Gulf War Veterans 395
Ch. 38 Retirees: Employment-Related Health Insurance Coverage 407
Ch. 39 Older Retirees: Supplements to Medicare Health Insurance Coverage 411
Ch. 40 Health Insurance for the Elderly: Owning Duplicate Policies Is Costly and Unnecessary 415
Ch. 41 Health Insurance for Children: Private Insurance Coverage Continues to Deteriorate 427
Ch. 42 Health Care: School-Based Health Centers Can Expand Access for Children 445
Ch. 43 America's Newcomers: Health Care Issues for New Americans 471
Ch. 44 Illegal Aliens: National Net Cost Estimates Vary Widely 493
Index 511
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