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Health Insurance and Third-Party Reimbursement

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Abstract

To illustrate from the start that this is a complex, highly varied, and often confusing field, let me assert that there is no such thing as health “insurance!” Your health is not being insured against the unlikely event that you will ever be sick or disabled. Rather, based on the premise that health care will be needed and is costly, we are simply prepaying expected costs in a uniform, generally monthly, premium amount. In group health plans/policies, the prepayment is leveled across a broader group. Expenditures become more predictable and administration and related costs become less per each subscriber. For some subscribers the leveled cost actually will be greater than what they might expend, while for others it will be less. Also, apart from accidents and “catastrophic” sickness or disorder, the decision to seek health care, where, from whom, and how often, has a high degree of electivity.

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References

  • Biofeedback in action. World Medical News 1973 47-60, March 9.

    Google Scholar 

  • BLK Group, The. Survey of clinical psychologists receiving payments under Title XIX of the Social Security Act: Draft Final Report to National Institute of Mental Health. Contract No. ADM-42-74-74.

    Google Scholar 

  • Bodenheimer, T. The hoax of national health insurance. American Journal of Public Health, 1972, 62, 1324–1327.

    Article  PubMed  CAS  Google Scholar 

  • Boronson, W. Diagnosing your health insurance. Money, 1974, 3, 39–51.

    Google Scholar 

  • California Business and Professions Code, Chapter 6.6 (commencing with Section 2900, as amended through 1979).

    Google Scholar 

  • DeLeon, P. H. Implications of national health policies for professional psychology. Professional Psychology, 1977, 8, 263–268.

    Article  Google Scholar 

  • Dörken, H. Laws, regulations and psychological practice. In H. Dörken and Associates, The professional psychologist today. San Francisco: Jossey-Bass, 1976.

    Google Scholar 

  • Dörken, H. The practicing psychologist: A growing force in private sector health care delivery. Professional Psychology, 1977, 8, 269–274. (a).

    Article  Google Scholar 

  • Dörken, H. CHAMPUS ten state claim experience for mental disorder: Fiscal year 1975. In C. Kiesler, M. Cummings, & G. Vanden Bos (Eds.), Psychology in national health insurance: A sourcebook. American Psychological Association, Washington, D.C.:1977.(b).

    Google Scholar 

  • Dörken, H. Foundations for medical care. Professional Psychology, 1978, 8, 175–7.

    Article  Google Scholar 

  • Dörken, H. Worker’s Compensation: Opening up a major market for psychological practice. Professional Psychology, 1979, 10, 834–840.

    Article  Google Scholar 

  • Dörken, H. Perspectives in national health insurance and rehabilitation. In E. Pan, T. Backer, & C. Vash (Eds.), Annual review of rehabilitation (Vol.1). New York: Springer, 1980.

    Google Scholar 

  • Dörken, H., & Webb, J. The hospital practice of psychology: An interstate comparison. Professional Psychology, 1979, 10, 619–630.(a).

    Article  Google Scholar 

  • Dörken, H., & Webb, J. Licensed psychologists in health care: A survey of their practices. In C. Kiesler, N. Cummings, & G. Vanden Bos, (Eds.), Psychology and national health insurance: A sourcebook. Washington, D.C.: American Psychological Association, 1979.(b).

    Google Scholar 

  • Dörken, H., & Webb, J. 1976 Third-party reimbursement experience: An interstate comparison by carrier. American Psychologist, 1980, 35, 355–363.

    Article  Google Scholar 

  • Dörken, H., & Webb, J. Licensed psychologists on the increase: 1974–79. American Psychologist, 1981, 36, 1419–1426.

    Article  Google Scholar 

  • Egdahl, R., et al. Fee for service health maintenance organizations. Journal of the American Medical Association, 1979, 241, 588–591.

    Article  PubMed  CAS  Google Scholar 

  • Follette, W., & Cummings, N. Psychiatric services and medical utilization in a prepaid health plan setting. Medical Care, 1967, 5, 25–35.

    Article  Google Scholar 

  • GLS Associates. Analysis of state programs which mandate mental health benefits under private health insurance. Final Report, June 29, 1979. NIMH #278-78-0040 (MH).

    Google Scholar 

  • Gottfredson, G., & Dyer, S. Health service providers in psychology. American Psychologist, 1978, 33, 314–338.

    Article  PubMed  CAS  Google Scholar 

  • Grinker, R. Foreword. In B. Garger, Follow-up study of hospitalized adolescents. New York: Brunner/Mazel, 1972.

    Google Scholar 

  • Hannings, R., et al. Forensic psychology in disability adjudication: A decade of experience. HEW Publication No. 72-10284, Washington, D.C.

    Google Scholar 

  • Harsham, P. What, me incorporate? Money, 1973, 2, 55–58.

    Google Scholar 

  • Hochberg, R., & Stunden, A. Psychology and compensation: A reimbursement handbook for California licensed psychologists. Los Angeles: Division of Clinical and Professional Psychology, California State Psychological Association, 1979.

    Google Scholar 

  • Jones, K., & Vischi, T. Impact of alcohol, drug abuse, and mental health treatment on medical utilization: A review of the research literature. Medical Care, December 1979, 17, Supplement, pp. 1–82.

    PubMed  CAS  Google Scholar 

  • Kristein, M., et al. Health economics and preventative care. Science, 1977, 195, 457–461.

    Article  PubMed  CAS  Google Scholar 

  • Levine, D., & Willner, S. The cost of mental illness, 1974 Mental Health Statistical Note No. 125, February 1976. DHEW Publication No. (ADM) 76-158.

    Google Scholar 

  • Markus, G., & O’Sullivan, J. Medicare-Medicaid. Congressional Research Service, Library of Congress, September 28, 1977.

    Google Scholar 

  • Moore v. Metropolitan. New York State Psychologist, 1974, 26, 4. Also published as Insurance Law upheld, New York State Psychologist, 1973, 25, 1 and 11.

    Google Scholar 

  • Mueller, M., & Gibson, R. Age differences in health care spending. Fiscal year 1975. Social Security Administration, DHEW Publication No. (SSA) 76-11700.

    Google Scholar 

  • National Register of Health Service Providers in Psychology. Washington, D.C: Council for the National Register of Health Service Providers in Psychology, 1978.

    Google Scholar 

  • U.S. Department of Health, Education & Welfare, Rehabilitation Services Administration, Final report on characteristics of clients rehabilitated during fiscal year 1974. Information memo No. RSA-IM-76-87. Washington, D.C., 1976.(a).

    Google Scholar 

  • U.S. Department of Health, Education & Welfare, Social Security Administration Staff Paper No. 21, Health Insurance Administrative Costs, DHEW Publication No. (SSA) 76-11856, 1976.(b).

    Google Scholar 

  • Virginia Academy of Clinical Psychologists v. Blue Shield of Virginia, U.S. Court of Appeals, 4th Circuit, No. 79-1345, Brief of American Psychological Association as Amicus Curiae, 1979.

    Google Scholar 

  • Von Korff, M., & Kramer, M. Mental and nervous disorders utilization and cost survey. National Institute of Mental Health, 1979, Mimeograph.

    Google Scholar 

  • Wiggins, J. Disability and rehabilitation services. In H. Dörken and Associates, The professional psychologist today. San Francisco: Jossey-Bass, 1976.

    Google Scholar 

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© 1983 Springer Science+Business Media New York

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Dörken, H. (1983). Health Insurance and Third-Party Reimbursement. In: Sales, B.D. (eds) The Professional Psychologist’s Handbook. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-1025-7_10

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  • DOI: https://doi.org/10.1007/978-1-4899-1025-7_10

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4899-1027-1

  • Online ISBN: 978-1-4899-1025-7

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