by: AllMed Healthcare Management
During the past 20 years, there has been a dramatic increase in obesity in the United States. Thirty states have obesity rates of more than 20 percent. Currently, more than 44 million Americans are considered obese, the result of our fast-food life style and lack of exercise.
As a result, more obese Americans are turning to bariatric surgery. In 1995, just 20,000 weight-loss operations were performed in the United States. Last year, physicians performed 103,000 bariatric surgeries, an increase of more than 500 percent. The projection for 2005 rises to 144,000.
These surgeries are in the range of $30,000 each and if complications arise, even more. Even though some health insurance groups do not include this surgery in their plan language, requests for independent medical reviews regarding bariatric surgery have surged over the past year.
Most of these reviews hinge on what's considered medically necessary or optional when it comes to bariatric surgery. As a claims manager, there are several issues to consider when making a decision about a patient's claim for bariatric surgery:
Is the person suffering from morbid obesity? (The term morbid obesity refers to patients who are 50-100% or 100 pounds above their ideal body weight.)
Has the patient failed one or more non-surgical multi-component weight loss programs? (Was this an evidence-based, integrated weight loss program ? such as the one offered by the Ornish Program ? that has sustainable, reproducible results?)
Does the patient have a medical illness related to obesity and is he/she willing to participate in a pre-surgery weight loss effort to improve the success of surgery? (Even a somewhat slimmer patient has reduced cardiac risk.)
Can the patient make the lifestyle adjustment necessary to sustain weight loss? (Many of the dietary limitations are more severe than those needed to lose weight in the first place.)
Only by answering these questions, or using the expertise of your IRO, can you make an informed decision as to whether the claim is medically necessary or considered a cosmetic procedure.
About The Author
AllMed Healthcare Management Founded in 1995, AllMed (http://www.allmedmd.com, http://www.allmedmd.com/blog/index.htm) is a URAC-accredited Independent Review Organization (IRO) serving insurance payers, providers, TPAs and claims managers nationwide. Reviews are conducted by board-certified physicians in active practice. AllMed's growing customer base includes premier organizations, such as Educator's Mutual Life, IMS Managed Care, Tenet Healthcare Corporation, HealthGuard, several Blue Cross Blue Shield organizations, TriWest Healthcare Alliance, Allianz and many other leading healthcare payers.
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HDTV is What Technology is All About
HDTV is What Technology is All About
by: Scott Bianchi
If you have not yet watched TV on an HDTV you do not know what you are missing.
When they promote high definition they aren?t kidding.
When my daughter was born I knew I?d be spending a lot of time at home so I invested in an HDTV and two years later I still think it was an excellent purchase.
Not only is the picture unbelievable but the sound is much improved as well.
More and more channels are starting to come out in HDVT format so buying an HDTV
makes much more sense now as compared to two years ago when I bought mine.
When I first got it I think there were only four channels I could watch in HD.
They happened to be four channels I watched a lot so it worked out well for me.
As time has passed the TV?s themselves become even cheaper and more channels are available so they are a much better purchase.
Many people are not...
HDTV is What Technology is All About
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Eyeshadow Essentials To Make Your Eyes Stand Out
Eyeshadow Essentials To Make Your Eyes Stand Out
by: Julia Brown
When it comes to makeup, eyeshadow is perhaps the trickiest product to apply. This is because the eyes have no real limitations. According to the makeup experts, each shape you create using eyeshadows can take you to different realms. Indeed, it was black kohl that transformed Elizabeth Taylor into Cleopatra and Audrey Hepburn into Holly Golightly. Eyeshadows do not only make your eyes look bigger, they can also add drama and draw attention to your eyes. However, it is one of the trickiest makeup products to apply, which explains why women do not wear it as often as lipstick. Drawing a perfect shade may often take some practice, but with a few expert tips and techniques, you can do it in no time.
1. Select the correct eyeshadow form
Eyeshadow comes in several formulations, each with a unique finish and level of difficulty. Matte eyeshadows blend easily and are perfect for...
Eyeshadow Essentials To Make Your Eyes Stand Out
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Polishing Your Sales Presentation
Polishing Your Sales Presentation
by: Dan Collins
Summer is here! It?s time to bring out your summer attire, take a vacation and reflect upon your achievements thus far this year. Look back at the past few months of your sales production . . . are you on target for all your sales goals for 2005? Are you making the sales from all your sales presentations?
You may be far ahead in some areas or behind in others. No matter what your sales production is today you certainly should have another look at what targets and goals you have developed in your game plan for 2005.
Are you using your strengths to their fullest potential? To improve your sales results, determine what has been working or not working. Then define where to concentrate your productive energies for the next two quarters in 2005 or the remainder of your compensation period.
The statistics say that 90% of the sale is made in the presentation. Many sales professionals need...
Polishing Your Sales Presentation
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Lens Flare - The Hidden Enemy Of Rear-Projection TVs
Lens Flare - The Hidden Enemy Of Rear-Projection TVs
by: Eli Aloisi
While one expects CRT-based rear projection televisions to deliver good black levels, there is a factor that can compromise black level performance in any rear-projection display.
This factor is something called lens flare. Lens flare is most commonly seen in photographs. It usually occurs when the photographer is shooting in the general direction of the sun. Bright sunlight enters the lens at an angle and bounces around inside the lens body. As it reflects off of the interior parts of the lens, some of it ends up getting on to the film, usually in the form of bright circles or shapes, broad smears of light, or lines.
Binocular, telescope, and camera lens manufacturers all try to make the inside of their optical assemblies as dark as possible and also add light baffles to try to waylay the misdirected light so that it does not spoil the image
Rear projection televisions...
Lens Flare - The Hidden Enemy Of Rear-Projection TVs
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LCD TV Checklist: Are you Prepared?
LCD TV Checklist: Are you Prepared?
by: Tim Jeffries
LCD flat screen TVs provide a superior picture as compared to a traditional television - and they can come in more attractive styles to boot.
A flat screen LCD TV can be mounted on a wall, under a cabinet, on the ceiling? or can sit on a stand or on top of furniture.
LCD TVs are versatile, flexible, and provide a better entertainment experience? but how do they work?
LCD flat screen TVs, and LCD technology itself, is based on the properties of polarized light.
LCD TVs consist of two, perpendicularly arranged panes of polarized glass "stuck together" by a liquid-crystal-filled polymer solution. When they are exposed to electrical currents, the crystals untwist to varying degrees, permitting specific amounts and colors of light to pass though them.
Flat screen LCD TVs are, in effect, projection TVs that depend on an extremely bright lamp as their light source,...
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Objective Meditations: What is Reality?
Objective Meditations: What is Reality?
by: Paul M. Jerard Jr.
Is reality a projection from within the mind, or is it an ?altered lens? into the outside world? Let?s look at the altered lens theory first. Obviously, we are not all looking at the world with the same lens or viewpoint. If that were possible, and we had a consistent moral code of ethics, we would have world peace.
Imagine no wars, conflict, divorce, or crime. It does make you think that John Lennon might have been thousands of years ahead of his time, when he wrote the lyrics for his song, ?Imagine.? Although, we may not agree with every word, the thought of global harmony captivates the mind.
Is this a reality? At this moment in time, it doesn?t look possible. Peace agreements seem so close, and then, an assassination, or a suicide bomb, changes everything. Why is this world not ready for a Mahatma Gandhi, Anwar Sadat, or Martin Luther King, Jr.?
Do we, as a species,...
Objective Meditations: What is Reality?
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