Sentence examples for coverage determinations from inspiring English sources

Discipline by the state over such coverage determinations, she wrote, is pre-empted by federal law.

This designation will promote access to prevention, treatment and comprehensive coverage determinations.

PacifiCare, based in Santa Ana, Calif., said in a statement that the ruling "disregards Congressional mandate and key U.S. Supreme Court decisions regarding Medicare coverage determinations".

These schemes lay down in great detail, in the form of national and local "coverage determinations", which treatments and procedures can be claimed for, and at what rates.

At the least, H.M.O.'s, like traditional insurers, will in some fashion make coverage determinations, scrutinizing requested services against the contractual provisions to make sure that a request for care falls within the scope of covered circumstances (pregnancy, for example), or that a given treatment falls within the scope of the care promised (surgery, for instance).

Compensation for pathologist and clinical laboratory services generally depends upon standardized procedural coding systems, the coverage determinations of individual insurance companies, fee schedules that assign reimbursement rates for those services, and contractual compensation arrangements.

"The board of medical examiners is getting involved in what is basically a benefit or coverage determination," he said.

So the decision of the agency to even undertake a formal "national coverage determination" aroused some controversy.

Such a national coverage determination was undertaken for Provenge, which costs $93,000 for a complete course of treatment.

Still, Mr. McLeod said that while there were no plans for one right now, he could not totally rule out that Medicare might one day undertake a national coverage determination to decide whether to pay for Avastin.

The national coverage determination drew outcries from some men with prostate cancer, investors in Dendreon and critics of health care reform, who said the government was singling out the drug because of its cost and was on its way to rationing health care.