Tag: St. Joseph’s Hospital

The Wisdom of Father Steve

I was surprised and delighted to run into Father Steve LaCanne at a celebration of life over the weekend (he officiated). Those with a HealthEast connection may recall that he was the longtime Director of Spiritual Care at St. Joseph’s Hospital, in downtown St. Paul, Minn.

Photo: Joan Frenz

And direct our spirits he did! Father Steve shared the following passage from Thomas Wolfe, which is a great meditation for the week:

To lose the earth you know, for greater knowing; to lose the life you have, for greater life; to leave the friends you loved, for greater loving; to find a land more kind than home, more large than earth—

—Whereon the pillars of this earth are founded, toward which the conscience of the world is tending—a wind is rising, and the rivers flow.

Father Steve is now semi-retired and splits his time between Minnesota and Florida. ✸

Think Like a Health Plan

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

  1. Is the health care service a covered benefit? (cf. benefit plan)
  2. Does the carrier have a policy concerning the health care service?
  3. In the absence of a specific policy, is the health care service medically necessary?
  4. Does the member (patient) and/or evidence meet criteria?

—

Benefit Plan

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).

—

Medical Policies

—

Medical Necessity

—

Group Exercise

# # #