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Dr Ward’s value to the scheme lies in his ability to provide a professional medical opinion whenever it’s needed. Product design is one such example. He works with our Principal Officer, management team and members of the Board to determine the provision of benefits across all our Plans, and to make sure that they’re in line with legislation.
When it comes to new membership applications, Dr Ward assesses the information provided by each prospective member. His opinion about the health of the member guides us in assessing risk and allocating cost.
When a clinical interpretation is needed for case management purposes, Dr Ward obtains and collates all medical information from the patient, doctor, hospital or case manager.
He also helps in our claims process, by
- informing us of the appropriateness of treatment pricing,
- making sure that we only pay for medically necessary or appropriate claims,
- and answering clinical queries when it comes to claim disputes.
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