In the Medicare program, this was formerly referred to as the appeal process . If a patient disagrees with any decision about health care services or if Medicare does not pay for an item or service, the initial Medicare decision may be reviewed again using this process. It has five levels: (1) redetermination (telephone, letter, or CMS-20027 form); (2) hearing officer (HO) hearing or reconsideration; (3) administrative law judge (ALJ) hearing; (4) Departmental Appeal Board review; and (5) judicial review in U.S. District Court.
Tag: RAW
Redlining
Civil rights issue wherein an insurance company denies coverage to questionable or high risks in a given geographical area.
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Unfair discrimination based not on the risk’s characteristics but on its location. The term is commonly associated with an insurer’s refusal to consider insuring any home or business within a specific area marked by a line drawn on a map.
Reduced paid-up insurance (Life Insurance)
A policy whose cash value can be used to buy paid-up insurance in the highest amount it can afford.
Reduced paid-up insurance option
See: nonforfeiture reduced paid-up benefit .
Reducing extra risk
A life insurance term referring to an extra risk which is at its greatest at the inception and then decreases, e.g. tuberculosis after treatment.
Reduction
See: fracture manipulation .
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A lessening in the amount of benefits paid out under a certain policy due to a particular condition.
Reduction for Health
A decrease in the benefits in a Health insurance policy because of a specified conditions. For example, benefits may be reduced because a disability is caused by a specific condition.
Reduction formula
Provision in an insurance policy that reduces the level of life insurance to another amount of coverage. This situation can occur when the insured reaches a specific age or retires.
Reduction of Risk
Taking steps to reduce the probability or severity of a possible loss. For example, installing alarms and sprinkler system to reduce the risk of fire loss to a building. One of the four major risk management techniques.
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One of the major risk management techniques. Taking precautionary measures to reduce the likelihood of a loss, or to reduce the severity of a possible loss; for example, installing a security system.
Reenroll
Inactive membership in an insurance plan that is reestablished using the same subscriber identification number and may be in the same group or a new group.