Reimbursement for Specific Services or Benefits

THIRD-PARTY PAYORS

Reimbursement for Specific Services or Benefits

RESOLVED, That the North Carolina Medical Society supports review of health care coverage and reimbursement requirements based on the following criteria:

  1. The service or procedure is required in a life-threatening emergency, or
  2. The service or procedure is required to prevent chronic disease, or
  3. The service or procedure is cost-effective, i.e., will prevent or reduce future health care expenditures, or
  4. The service or procedure would be considered by prudent laypersons to be a standard provision in a health insurance benefit package, or
  5. The service or procedure is based on generally accepted standards of medical practice, based on credible scientific evidence published in peer-reviewed medical literature and generally recognized by the relevant medical community.

(Report F – 2004, adopted 11/14/2004)
(reaffirmed, Report I-2009, Item 2-28, adopted 11/01/2009) (reaffirmed, Reaffirmation Report-2014, Item 14, adopted 10/25/2014)

 
 

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