Years ago, in one of my former lives, Scott Hinrichs, HealthEast’s vice president for mission, bioethics and spiritual care, tapped me to speak at its annual President’s Prayer Breakfast. I’m not sure that the audience walked away with much, however, the event was a tremendous gift to me. Absent the commitment, I doubt that I would have reflected on my spiritual journey.
The PowerPoint has generally aged well. I’m not sure that I would add much today—except, perhaps this Lars Kenseth cartoon, which I saw over the weekend, and some stuff from Stephan Bodian’sBeyond Mindfulness. By all means laugh, but then puzzle for a few minutes over the deeper meaning.
What’s that part of you that’s been there all along?
— Postscript. I didn’t immediately realize that today marks the 10th anniversary of my presentation. More than coincidence? ✸
In one of my lives (I have a few), I serve as the medical director for a commercial health plan. My duties involve developing policies and reviewing claims. It’s the greatest job on earth if you love evidence-based medicine (which I do!). And it connects perfectly to another life: teaching EBM at the University of Minnesota, which I’ve been doing since 2004.
I’m pleased to return to St. Joseph’s Hospital, my former employer and postgraduate alma mater, on August 20th to discuss health insurance with the family residents.
This post contains my key teaching points and didactic materials.
Suggested Thought Process
Is the health care service a covered benefit? (cf. benefit plan)
Does the carrier have a policy concerning the health care service?
In the absence of a specific policy, is the health care service medically necessary?
Does the member (patient) and/or evidence meet criteria?
At a very high level, benefits are determined by the member’s benefit plan. Eligible services are subject to the plan’s terms, as often summarized in medical policies. Excluded services are not eligible for coverage and cannot be funded by the plan (doing so would violate a contact with the plan’s owner).