IHP 630 week 1 discussion

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School

Southern New Hampshire University *

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Course

630

Subject

Health Science

Date

Jan 9, 2024

Type

docx

Pages

2

Uploaded by belkisa05

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Hi Everyone, My Name is Belkisa, and I go by Beki. I currently live in the southwest suburbs outside of Chicago. I have been in the health care industry for about 16 years. I have worked and different type of specialties as a medical assistant. I'm currently a clinical supervisor for five obstetrics and gynecology clinics. I love what I do and get to see the beautiful Mamas go through their pregnancy and meet the little angels at the end of the road. For as long as I can remember I have always wanted to work in the healthcare industry. Throughout so many years I have been under different type of management and always knew I wanted to be a leader and be that person that my team members can come to right think they may need. My door is always open to my staff, and I am always available via, email, text or in person. I graduated from SNHU in May of 2021 with a BS of Healthcare Administration and Management. I told myself I would take a year break and go back for my Masters, and this is exactly where I am today. I want to be able to grow within my career and become a Practice Manager or Director. I would love to run my own clinic. In my free time I like to hike, visit the zoo with my son, go to the pool, BBQ, and lay out in the sun. Within the healthcare industry there are many different avenues of procedures, testing, billing, and insurance coverage benefits. As healthcare employees we must be educated on these in order to be able to explain and answer any questions to our patients. every patient has the right to question the procedure, risks, costs, charges associated and if the insurance would actually cover the services rendered. 1. How much would the procedure cost because I have not yet met my deductible? As the healthcare provider/facility we would contact the insurance to check the benefits, what services are covered, how much the deductible is and if it has been met. Along with this we need to verify the out-of-pocket costs as well. Once we know how much of the patient’s deductible and out of pocket is we can roughly give an estimate of what they would be charged for. 2. Do I need pre-authorization? Upon contacting the insurance to verify benefits we need to know if this procedure requires a prior authorization. If the procedure requires one, it needs to be done within the timeframe of insurance requirements of the patient can get stuck with the entire bill for the procedure as it was not authorized by their insurance. 3. Is there a facility charge in addition to the physician charge? There are always additional charges on top of the procedure charges themselves. The overhead charge for the facility, equipment, lab work, anesthesia, and medication each of these need to be charged for and the patient is to be notified that there are overhead costs that come with any facility, provider, and facility.
4. What other charges would be incurred? The other charges incurred would for any medications administered, laboratory testing, pathology testing, overnight stay, or complications that may cause the procedure to be longer or need to go back into surgery. Any of these charges can take place outside of the procedure itself. As patients do not really understand how the billing in the healthcare industry works, they may have a perception of the payments towards services being rendered. As we have seen in history many people are hesitant to seek care when they know there is a large cost associated with it. If a patient has a high deductible or out-of-pocket max, they will also not want to proceed due to financial hardship, which in turn results in poor health outcomes and possibly even death. Being able to educate our patients on financial assistance, obtaining proper authorization for procedures, and following guidelines would lessen the cost out-pf-pocket for them. Reference Casto, A. (2021). Principles of Healthcare Reimbursement. [MBS Direct]. Retrieved from https://mbsdirect.vitalsource.com/#/books/9781584268017/ Pestaina, K., & Pollitz, K., May 20,2022 Examining Prior Authorization in Health Insurance retrieved from https://www.kff.org/policy-watch/examining-prior-authorization-in-health- insurance/ How do Deductibles, Coinsurance and Copays work? Retrieved from https://www.bcbsm.com/individuals/help/how-health-insurance-works/deductibles- coinsurance-copays/
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