Essay about Blue Cross and Blue Shield of South Carolina

Managed care dominates health care in the United States. It is any health care delivery system that combines the functions of health insurance and the actual delivery of care, where costs and utilization of services are controlled by methods such as gatekeeping, case management, and utilization review. Different types of managed care plans came into development by three major factors. These factors include choice of providers, different ways of arranging the delivery of services, and payment and risk sharing. Types of managed care organizations include Health Maintenance Organizations (HMOs) which consist of five common models that differ according to how the HMO is related to the participating physicians, Preferred Provider Organizations

Medicare and Medicaid are programs that have been developed to assist Americans in attainment of quality health care. Both programs were established in 1965 and are federally supported to provide health care coverage to vulnerable populations such as the elderly, the disabled, and people with low incomes. Both Medicare and Medicaid are federally mandated and determine coverage under each program; both are run by the Centers for Medicare & Medicaid Services, a federal agency ("What is Medicare? What is Medicaid?” 2008).

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This week I began my 6-week internship at Blue Cross Blue Shield of Nebraska (BCBSNE). The first day was a common orientation for all new employees, internally denoted to as the “onboarding process” where all employees are told they matter. This full-day session communicates the core mission, vision and goals of BCBSNE, organizational structure, operating objectives, and workplace culture. BCBSNE is a not-for-profit health insurance company that is focused on collaboration to find the best solution for their customers; in other words, they are customer-focused. Since the implementation of the Affordable Care Act (ACA), many changes to the health insurance market required a change in the organizational structure and culture of BCBSNE. Through partnerships with providers, the goals of BCBSNE are to be responsive, accountable, minimize errors, and decrease costs – all components of the ACA. BCBSNE has strategically aligned their goals to those of the government-mandated goals, and implemented them at all levels of the organization, making them competitive in the health insurance market. I found this very fascinating: I was very excited after day one!

Health insurance in the United States is not a single nationwide system and is much more diverse in terms of production methods (Ridic, Gleason & Ridic, 2012). Health insurance is either purchased privately or provided to some public groups from the government, mainly Medicare and Medicaid (Ridic, Gleason & Ridic, 2012). Medicare is a nationally run program for aged and disabled individuals (Ridic, Gleason & Ridic, 2012). Medicaid provides coverage economically disadvantaged groups (Ridic, Gleason & Ridic, 2012). The Affordable Care Act of 2012, established a shared responsibility between the government, employers and individuals ensuring all Americans have access to affordable health insurance (The Commonwealth Fund, 2016). For private

Is national certification important with respect to billing and reimbursement? When? Discuss reimbursement barriers and issues that hinder or prevent APNs from receiving reimbursement for services rendered. What are steps APNs must take to increase the likelihood for reimbursement?

The terminology (i.e., Federal health care programs) contains any program that provides medical benefits, even if directly, by means of insurance, that is paid directly, in full or in part, by the US Government (i.e., Through programs such as Medicare, Federal Employees Health Benefits Act, Federal Employees’ Compensation Act, the Longshore and Harbor Worker’s Compensation Act) or any State health plan (e.g., Medicaid, or a program receiving funds from block grants for social service plan requirements. Guidelines, an industry should have

The U.S. health care system is a scrutinized issue that affects everyone: young, old, rich, and poor. The health care system is comprised of three major components. Since 1973, most Americans have turned to managed-care programs, known as HMOs. The second type of health care offered to Americans is Medicare, health care for the elderly. The third type of health care is Medicaid, a health care program for the poor.

SCHIP stands for State’s Children Health Insurance Program introduced in January 24, 1997. The bill is part of the Balanced Budget Act of 1997 which was signed by President William Clinton in August 5, 1997 and became a public law1. The bill allows the States to designate the fund given by the federal government to families that qualifies under certain conditions. However, in September 7, 1997 it received a disapproval bill originating from the House. And in 2007, during the 110th Congressional session, the House introduced the State’s Children Health Insurance Program Reauthorization Act of 2007, H.R. 3963. The bill is introduced by the House Representative John D. Dingell and was placed under House Calendar No. 141 with one general

Medicare and Medicaid are two of the United States largest broken systems, which must sustain themselves in order to provide care to their beneficiaries. Both Medicare and Medicaid are funding by a joint effort between the federal government and the local state government. If and when these governments choose to cut funding or reduce spending, Medicare and Medicaid take the biggest hit. Most people see these two benefits as one in the same, two benefits the government takes out of their pay check to help fund health care. While the government does deduct a sum from paychecks everywhere, Medicare and Medicaid are very two very different programs.

Medicaid and Medicare are two different government programs. Both programs were created in 1965 to help older and low-income families be able to buy their own private health insurance. These programs were part of President Lyndon Johnson’s “Great Society” plan, a commitment to helping meet the needs of individual health care. They are social insurance programs, which allow the financial load of patient’s illnesses to be shared by other healthy, sick, wealthy, and lower income individuals and families.

Blue Cross and Blue Shield of Illinois (BCBS) is considered the largest and most experienced insurance company in Illinois. BCBS was founded in order to provide healthcare to teachers at a reasonable cost. It services over 7 million people. Its mission is “To promote the health and wellness of members and communities through accessible, cost-effective, quality health care” (Blue Cross Blue Shield, 2012). Blue Cross Blue Shield provides its customers with affordable health care. The parent company is Blue Cross Blue Shield Association its signature tag is “Creating Healthier Communities,” BCBS does not have any investors and the customers are considered the investors of the company and essentially who BCBS answers to. This is an important factor because they do not have to keep investors interest in the forefront of decision making, but rather they have the interest of their client in mind. (Blue Cross Blue Shield, 2012) In 2013 the Chicago based company reported profits of 684.3 million dollars. The company employees over 17,000 people. “Blue Shield of Illinois fell well below the $1 billion mark for the first time since 2009, in part because the insurance giant is setting aside money to offset expected losses from the troubled rollout of Obamacare” (Wang, 2014). Despite this setback it continues to expand over various parts of the United States. BCBS

Healthcare didn’t always exist in the United States. Before the 1920’s, most people didn’t have health coverage. Most people were treated at home and hardly anyone, except a few large employers offered healthcare. Everyone else paid out of pocket. As the population shifted from rural areas to urban centers, families lived in smaller homes with less room to care for sick family members (Faulkner 1960, p. 509). Increasing requirements for licensing and accreditation, in addition to a rising demand for medical care, eventually led to rising costs. By the end of 1920s, there was an increased demand for medical care and the costs of medical care increased.

The higher cost of affordable Health care is also eroding the ease with which to afford other insurance that covers about 30 percent of Medicare enrollees ‘expenses. In 2005, about 89 percent of beneficiaries obtained such additional coverage, including through former employers (33 percent), medical policies (25 percent), Medicare advantage plans (13 percent), Medicaid (16 percent), or other programs (1 percent) (MedPAC). These supplemental insurance programs were all very helpful at the onset, but with the passage of time and as health care costs continued to rise, employers are finding it difficult to support these programs and as a consequence, a greater number of these employers are either reducing the benefit or eliminating these benefits especially those that affects their retirees thereby increasing the cost of these supplemental insurances.

UnitedHealth Group is a diversified health care company, and a worldwide leader in helping people live healthier lives and taking the necessary steps in making the health system work better for everyone. The UnitedHealth group serves more than 85 million individuals worldwide with health benefits and services. In 2012, they produced revenues of $110.6 billion and were ranked number 17 in the Fortune 500. The economic and political segments would rank the highest in influencing the UnitedHealth Group.