Thank you for your follow-up related to this Fast Appeal for Mrs. Letha Washington. You have been very instrumental in ensuring that Mrs. Washington got the necessary medical referrals while here in Houston, TX and we truly thank you for all you have done in that area. This letter is a direct rebuttal to your Grievance Resolution letter dated 2/5/16: 1. In your letter on page 2 you stated “ Per the Centers for Medicare and Medicaid Services (CMS) guidelines, Cigna-HealthSpring is required to mail a letter acknowledging receipt and processing of a Customer’s enrollment application.” a. Let me be very clear the letter from American Benefit Services (ABS) Mrs. Chris Drury - Medicare Benefit Specialist whom is an agent for Cigna-HealthSpring dated 9/29/15 states “ It was a pleasure working with you and I am very pleased to be able to help you continue your coverage with Cigna-HealthSpring.” “Just a reminder, the doctor we chose for you was Dr. Michael Buxbaum at 1214 Hermann Dr, Ste 230, Houston, TX 77004”. b. Clearly this acknowledgement letter informs us that we have secured Cigna- HealthSpring coverage in Houston, TX. Please find attached the full letter from ABS your agent. i. Once we received confirmation of coverage we started the process of moving Mrs. Washington to Houston, TX. As we …show more content…
Goodson, we are certain that Mrs. Letha Washington has been negatively impacted due to negligence on behalf of Cigna-HealthSpring and its agents. Mrs. Washington would not have incurred the expenses to move to Houston, TX if she did not have confirmation of insurance coverage. We are requesting that a special enrollment be made for Mrs. Washington to allow her coverage in the Cigna- HealthSpring Texas with ESRD. We will also be contacting CMS to explain to them that we feel we have been negatively impacted due to your sanctions on 1/22/16, we will be requesting a special enrollment and waiver of the ESRD so that she may enroll in the Cigna-HealthSpring of
He claimed he was only asked to complete a few questionnaires with no further evaluation. When he was given his treatment plan, R.G. felt it did not address his needs and goals. When he started EMDR, he did not feel comfortable with the individual providing this service and requested to see either Dr. Earle or another clinician. The individual administering the EMDR refused and stated he had goals that needed to be met and there were no alternatives. R.G. was very upset by this and later went to the emergency room (ER) in crisis.
The female patient was irate, uncooperative, and exhibiting violent behavior with the nursing staff and Physician. She wanted to leave the hospital and refuse to talk to the staff. The patient throws her SCID card in the trash and I pulled it out of the trash can and place it with her paper work. The female patient received
An EMTALA Case Mary Carnahan HA 301 Legal Aspects Legislation in Health Care March 17, 2016 Introduction This research paper is about a case law for a federal appellate circuit for an EMTALA case. Describe the case and the EMTALA requirement(s) at issue. How does it relate to the professional standards a medical professional must follow?
INTRODUCTION: This case involved Giselle Hernandez being a danger to herself. Hernandez was transported to the Exodus Urgent Care Center, where she was placed on a WIC 5150 hold. INVESTIGATION: On 09-07-17 at approximately 1542 hours, LA County Clinician Vasquez #433353
Seagate provided health care benefits to its employees by contracting with a health maintenance organization (HMO) known as Medica” (Shea v. Esensten, 1997). Although Mr. Shea needed a referral to a cardiologist, there was a specific reason for his physician not giving him the referral he needed. “Specifically, the primary care doctors were rewarded for not making covered referrals to specialists, and were docked a portion of their fees if they made too many” (Shea v. Esensten, 1997). Mrs. Shea clearly states that if her husband would have known the following circumstances, he would sought a cardiologist on his own and still be alive.
The HHS was conducting investigation on the clinic about these complaints from the patients. The hospital system also moved all its clinics to the new building called the stratus building. They also replaced all the systems with the new systems that support for the Cerner live. One of the contractors from the IT deployed the new computer to the clinic and he pick up the old computer from the clinic and come to the office and put the computer on the shelf where the junk computer was placed. The contractor forgot to fill up the disposal instructions for the computer.
The case involves Frances Hector versus Cedars-Sinai Hospital. Hector had a defective pacemaker implanted at the hospital. Hector then attempted to sue Cedars-Sinai claiming that they were primarily involved in selling the pacemaker and providing the services of implanting the device was secondary. The question is who won? What about the policy that supports the mixed sale doctrine?
The provider went on to say she had 8 claims and had questions which Dina answered them all and was very patient and knowledgeable. The provider mentioned Dina needs a personal extension so she can call her directly as she’s very professional and knows she will have great customer service when getting her on the
John could bring a negligence claim to court against PharmaCARE if he can show that the drug firm had an responsibility to act with ordinary or reasonable care toward a person or the general public. In this case, PharmaCARE being a drug company marketed the drug because it believed the drug to be safe and therefore had an obligation to act with ordinary or reasonable care by clinically testing the new formulation before being distributed. The defendant's action did not meet this duty, and the defendant's action or failure to act caused harm to the plaintiff. PharmaCARE had a legal duty to ensure that its drugs were clinically tested even though it was a new formulation. In not conducting trials on the new formulation, PharmaCARE did not meet
The lower the funds go it can cause for some federally qualified health centers to close this alternative options for undocumented patients or reduce the amount of people who will be qualified to get this care. Several of Americans have the benefit to now have low insurance cost along with medical bills. The conflict here appears when undocumented patients have to be turned away due to the fact they are a financial burden on the health center. The guidelines strictly state that the undocumented patients are able to use this care in time of emergency or primary care. This is why they get discharged even if the patient has a terminal illness, or condition.
At the time of the event, a bar coding system for all medication had been in effect for a duration of two weeks, however, Thao had been gone one of those crucial weeks. Because of her absence, she did not receive the adequate training, instead, she received a sped
The patient reports that she hasn 't changed mental health providers frequently; she only changed due to the commute. This writer strongly advised the patient to work with DCF pertaining to her case and gather her information regarding to her mental health services to show that she is in compliance with treatment as it would be beneficial for her case. This writer provided encouragement to the patient as a mother and continuing to stay motivated on her fight for
• DFCS assistance: Medicaid • DFCS History- yes same related issue • Income-Logistic-transport clothes in and out of the country. • DOB: Denikca Davis-4/23/1986 A’Neeya Belton-1/28/2008 • CM Gilmore explained Hipaa and release form information-signatures were provided by Bmo. • CM Gilmore observed the home being clean, minor clutter but no safety concerns. All appliances were working (the hot water in the bathroom at the sink had to be turned on under the sink).
Health Care Law: Tort Case Study Carolann Stanek University of Mary Health Care Law: Tort Case Study A sample case study reviewed substandard care that was delivered to Ms. Gardner after having sustained an accident and brought to Bay Hospital for treatment. Dr. Dick, a second-year pediatric resident, was on that day in the ED and provided care for Ms. Gadner. Dr. Moon, is the chief of staff and oversees the credentialing of all physicians at Bay Hospital.