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Plastic and Reconstructive Surgery.... Oct 2023Despite evidence documenting the physical and psychological benefits of breast reduction, third-party payer approval remains a cumbersome process. The objective of this...
BACKGROUND
Despite evidence documenting the physical and psychological benefits of breast reduction, third-party payer approval remains a cumbersome process. The objective of this study was to assess differences in medical necessity criteria for reduction mammaplasty among US insurance carriers while analyzing trends in claim denials and appeals.
METHODS
The medical necessity criteria for reduction mammaplasty were retrieved from seven large health insurance carriers. Data were extracted from each policy, including claim requirements for approval. Additionally, prospective data on claims and denials submitted from January through August 2022 were collected from The Auctus Group, a medical consulting firm.
RESULTS
All the policies have been updated since January 2020. Five of the seven policies specifically listed what documentation was required for preauthorization approval, with five third-party payers requiring photograph documentation. Policies required documentation of one to three symptoms lasting from 6 weeks to 1 year. All companies reported a tissue resection estimate threshold, but cutoffs varied. Of 380 reduction mammaplasties performed, 158 (41.6%) received a denial on initial insurance submission. Considering appeals, a total of 216 denials were reviewed with an average of 1.37 denials per patient. Of the 158 initial denials, 104 (65.8%) of these were from claims that received preauthorization. In 12 cases, third-party payers stated that no prior authorization was necessary yet still denied the claim.
CONCLUSIONS
Wide variability exists in medical necessity criteria for reduction mammaplasty policies among major insurance carriers. These nuances introduce inefficiencies for practices contributing to high denial and appeal rates while delaying surgical care for patients.
PubMed: 37900990
DOI: 10.1097/GOX.0000000000005361 -
Annual Review of Public Health Apr 2021Climate change presents a challenge at multiple levels: It challenges our cognitive abilities because the effect of the accumulation of emissions is difficult to... (Review)
Review
Climate change presents a challenge at multiple levels: It challenges our cognitive abilities because the effect of the accumulation of emissions is difficult to understand. Climate change also challenges many people's worldview because any climate mitigation regime will have economic and political implications that are incompatible with libertarian ideals of unregulated free markets. These political implications have created an environment of rhetorical adversity in which disinformation abounds, thus compounding the challenges for climate communicators. The existing literature on how to communicate climate change and dispel misinformation converges on several conclusions: First, providing information about climate change, in particular explanations of why it occurs, can enhance people's acceptance of science. Second, highlighting the scientific consensus can be an effective means to counter misinformation and raise public acceptance. Third, culturally aligned messages and messengers are more likely to be successful. Finally, climate misinformation is best defanged, through a process known as inoculation, before it is encountered, although debunking techniques can also be successful.
Topics: Climate Change; Communication; Humans
PubMed: 33355475
DOI: 10.1146/annurev-publhealth-090419-102409 -
Psychosocial Intervention May 2023Intimate partner violence (IPV) perpetrators often deny their actions, limiting opportunities for intervention. Cisgender male couples experience similar IPV rates to...
Intimate partner violence (IPV) perpetrators often deny their actions, limiting opportunities for intervention. Cisgender male couples experience similar IPV rates to mixed-gender couples, yet less is known about how men in same-sex relationships deny or report their IPV behavior. This study aimed to describe perpetration denial across emotional, monitoring/controlling, and physical/sexual IPV, and to identify correlates of perpetration denial, in a convenience sample of male couples ( = 848; United States, 2016-2017). Past-year victimization and perpetration were measured with the IPV-Gay and Bisexual Men (GBM) scale; perpetration deniers were men whose self-reported perpetration contradicted their partner's reported victimization. Individual-, partner-, and dyadic-correlates of perpetration denial, by IPV-type, were identified using actor-partner interdependence models. We identified 663 (78.2%) perpetrators: 527 emotional; 490 monitoring/controlling; 267 physical/sexual. Thirty-six percent of physical/sexual-, 27.7% of emotional-, and 21.43% of monitoring/controlling-perpetrators categorically denied their actions. Depression was negatively associated with denying monitoring/controlling-perpetration (odds ratio 95% confidence interval: 0.91 [0.84, 0.99]) and physical/sexual-perpetration (0.91 [0.83, 0.97]); dyadic differences in depression were associated with emotional-perpetration denial (0.95 [0.90, 0.99]). Recent substance users had 46% lower odds of monitoring/controlling-denial (0.54 [0.32, 0.92]), versus non-users. Partner-race and employment were also significantly associated with emotional perpetration denial. This study highlights IPV denial's complexities, including differences across IPV types. Further investigations into how cisgender men in same-sex couples perceive and report various types of IPV perpetration will provide valuable insight into how an underserved and understudied population experiences IPV.
PubMed: 37383641
DOI: 10.5093/pi2023a8 -
Soins; La Revue de Reference Infirmiere Sep 2021Incest is a fundamental prohibition whose transgression leads to critical but very often invisibilized consequences. It is crucial to take into account the...
Incest is a fundamental prohibition whose transgression leads to critical but very often invisibilized consequences. It is crucial to take into account the specificities relating to this prohibition to understand all the dimensions of its violence and effects. Its unthinkable nature, its multiple modalities and the social denial that surrounds it are all obstacles that prevent it from being fully understood.
Topics: Humans; Incest; Violence
PubMed: 34462071
DOI: 10.1016/j.soin.2021.07.011 -
Science Advances Sep 2022The U.S. Supreme Court's decision will lead to more criminalization of activities during pregnancy, more abortion denials, and more abortions after the first trimester. (Review)
Review
The U.S. Supreme Court's decision will lead to more criminalization of activities during pregnancy, more abortion denials, and more abortions after the first trimester.
PubMed: 36070372
DOI: 10.1126/sciadv.ade5327 -
Frontiers in Psychology 2020While a number of empirical studies have appeared on impaired self-awareness (ISA) after traumatic brain injury (TBI) over the last 20 years, the relative role of denial... (Review)
Review
While a number of empirical studies have appeared on impaired self-awareness (ISA) after traumatic brain injury (TBI) over the last 20 years, the relative role of denial (as a psychological method of coping) has typically not been addressed in these studies. We propose that this failure has limited our understanding of how ISA and denial differentially affect efforts to rehabilitate persons with TBI. In this selective review paper, we summarize early findings in the field and integrate those findings with more recent observations (i.e., 1999-2019). We believe that this synthesis of information and expert clinical opinion will inform future research on ISA and denial as well as approaches to rehabilitation for persons with TBI.
PubMed: 32765359
DOI: 10.3389/fpsyg.2020.01569 -
Psychotherapy and Psychosomatics 2023Illness denial pertains to medical patients who do not acknowledge the presence or severity of their disease or the need of treatment. (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Illness denial pertains to medical patients who do not acknowledge the presence or severity of their disease or the need of treatment.
OBJECTIVE
This systematic review was performed to clarify the clinical role and manifestations of illness denial, its impact on health attitudes and behavior, as well as on short- and long-term outcomes in patients with medical disorders.
METHODS
The systematic search according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines was conducted on PubMed, Scopus, and Web of Science.
RESULTS
The initial search yielded a total of 14,098 articles; 176 studies met the criteria for inclusion. Illness denial appeared to be a relatively common condition affecting a wide spectrum of health attitudes and behavior. In some cases, it may help a person cope with various stages of illness and treatment. In other situations, it may determine delay in seeking treatment, impaired adherence, and reduced self-management, leading to adverse outcomes. The Diagnostic Criteria for Psychosomatic Research (DCPR) were found to set a useful severity threshold for the condition. An important clinical distinction can also be made based on the DCPR for illness denial, which require the assessment of whether the patient has been provided with an adequate appraisal of the medical situation.
CONCLUSIONS
This systematic review indicates that patients with medical disorders experience and express illness denial in many forms and with varying degrees of severity. The findings suggest the need for a multidimensional assessment and provide challenging insights into the management of medical disorders.
Topics: Humans; Psychophysiologic Disorders; Denial, Psychological
PubMed: 37429268
DOI: 10.1159/000531260 -
Journal of Nuclear Medicine : Official... Jul 2022
Topics: Edetic Acid; Gallium Isotopes; Gallium Radioisotopes; Glutamate Carboxypeptidase II; Positron Emission Tomography Computed Tomography
PubMed: 35772954
DOI: 10.2967/jnumed.121.264374 -
The Journal of Physiology Jan 2022Locomotion on complex terrains often requires vision. However, how vision serves locomotion is not well understood. Here, we asked when visual information necessary for...
Locomotion on complex terrains often requires vision. However, how vision serves locomotion is not well understood. Here, we asked when visual information necessary for accurate stepping is collected and how its acquisition relates to the step cycle. In cats of both sexes, we showed that a brief (200-400 ms) interruption of visual input can rapidly influence cat's walking along a horizontal ladder. Depending on the phase within the step cycle, a 200 ms period of darkness could be tolerated fully without any changes to the strides or could lead to minor increases of stride duration. The effects of 300-400 ms of visual input denial, which typically prolonged stances and/or swings, also depended on the phase of the darkness onset. The increase of the duration of strides was always shorter than the duration of darkness. We conclude that visual information for planning a swing is collected starting from the middle of the preceding stance until the beginning of the current swing. For a stance (and/or a swing of the other paw), visual information is collected starting from the end of the previous stance and until the middle of the current stance. Acquisition of visual information during these windows is not uniform but depends on the phase of the step cycle. Notably, both the extension of these windows and their non-homogeneity are closely related to the pattern of gaze behaviour in cats, described previously. This new knowledge will help to guide research and understanding of neuronal mechanisms of visuomotor integration and modulation of visual function by strides during locomotion. KEY POINTS: Cats, like humans, rely on vision to navigate in complex environments. In cats walking along a horizontally placed ladder, we show that visual information required for accurate stepping is collected in a non-uniform manner throughout the stride cycle. Brief denial of visual input during a swing prolongs the next stance of that forelimb. Denial of visual input during a stance prolongs this stance, as well as the next swing and stance. Denial during the first half of a stance has a greater effect than during the second half. The phase dependence of the use of vision for accurate stepping and the pattern of affected swings and stances are closely related to the previously described pattern of gaze behaviour in cats. This new knowledge opens new perspectives for research into neuronal mechanisms of visuomotor coordination and visual function during walking and for understanding related disorders.
Topics: Animals; Cats; Darkness; Electromyography; Female; Forelimb; Locomotion; Male; Walking
PubMed: 34761816
DOI: 10.1113/JP282255 -
Orphanet Journal of Rare Diseases Oct 2022Severe combined immunodeficiency (SCID) is a group of rare genetic disorders that cause disruption in immune system functioning. Parents of children with SCID experience...
BACKGROUND
Severe combined immunodeficiency (SCID) is a group of rare genetic disorders that cause disruption in immune system functioning. Parents of children with SCID experience many uncertainties related to their child's diagnosis, treatment, recovery, and quality of life. To fully understand parents' experiences throughout their SCID journey, it is important to explore the stressors generated by such uncertainties and how parents cope with these stressors.
METHODS
We conducted 26 in-depth interviews with parents whose child was diagnosed with SCID or a SCID-like condition through newborn screening. The interviews explored uncertainties related to their child's diagnosis and how parents coped with these uncertainties. Transcripts were generated from the interviews and analyzed using an inductive content analysis approach which included data immersion, generation and assignment of codes, and interpretation.
RESULTS
Parents used a variety of behavioral, cognitive, and affective coping strategies which evolved throughout their SCID journeys. Some parents reported coping by playing an active role in their child's treatment, which included reaching out to other SCID parents or seeking second medical opinions. Other types of coping included establishing house hygiene rules, thinking positively about the child's treatment progress, and relying on family members for help. These coping strategies were both deliberate and intuitive. Participants also described their struggles in coping with stressors related to their child's health and survival. They reported difficulty in processing their emotions and experiencing denial and guilt related to their child's diagnosis. Some parents adapted to ongoing uncertainties through such strategies as positive thinking, self-reflection, and relying on family and community. With successful adaptation, parents emphasized that they continue to use these strategies today.
CONCLUSION
Our assessment revealed that parents of children diagnosed with SCID use a variety of behavioral, cognitive, and affective approaches to cope with SCID uncertainties. Although parents reported challenges in coping with SCID uncertainties, they also reported finding ways to overcome these stressors and establish patterns of effective coping. Findings from our study can serve as a guide for parents whose child was newly diagnosed with SCID and for providers such as social workers, genetic counselors, and psychologists.
Topics: Child; Infant, Newborn; Humans; Quality of Life; Severe Combined Immunodeficiency; Stress, Psychological; Adaptation, Psychological; Parents
PubMed: 36303152
DOI: 10.1186/s13023-022-02554-9