Case Study Hcs/490

Health care plans are policies created to aid the patients in accessing medical services in form of insurance to cover the expenses incurred during treatment and hospital care. In analyzing the options given by two major health care plans elaboration will be based on two major insurance schemes namely indemnity insurance plan and Managed Care plan. All these vary yet with a common aim of providing medical services to the patients. In order for the analysis, consideration will be based on the costs and the coverage. These two plans differ in many important ways, more so in regard to how the services are offered, the way to obtain special care and the cost of care after recovery. Despite the diversities, the two care types share many

Review the Medicare coverage for Home Health. What are the typical services covered and not covered?

As far as insurance plans go, generally there are three plans a patient will have, they are Health Maintenance Organization (HM0), Preferred Provider Organization (PPO) and Point-of-Service (POS).

Medicare Parts A and B. There is a monthly premium for this coverage (Medicare 2013 costs at

The patient is informed about their coverage and the amount of copayment they would have to pay.

Plan A has a 20% coinsurance after deductible for an office visit for primary doctors. I would use this when injured or for an illness. Plan B has

plan, you will typically have no deductible and the co-payments often range from $10 to $20

Unit 2 AssignmentKelley WhitcombKaplan UniversityHI215-01: Reimbursement MethodologiesProfessor Kathleen SobelJuly 20, 2015Medicaid is one of the biggest insurance plans you can get in any state. In the state of Indiana, it is based off of your income. There is a certain amount (income) you have to make to determine if you will receive Medicaid or Healthy Indiana Plan (HIP). HIP is still a form of Medicaid, but you would have to pay monthly cost for it and have certain set of co-pays for certain services that is needed. HIP Plus is the recommended plan for members as it provides health coverage for a low, predictable monthly cost. HIP Plus also covers dental and vision services. If you do not pay your monthly payment you can be removed from

Managed care organizations should have arrangement with both the medical insurers and providers to provide treatment for a contracted rate. Hospital should advertise the services they offer to members of healthcare plans through their healthcare provider by emphasizing on the technology, staff, and other quality of care they provide. Worker compensation plans are similar to commercial plans but treats injured employees. Hospital must contract with all workers compensation plans and must also negotiate coordination of benefits with other insurance carriers of the injured person to full compensate services. For Self pay patients hospital can reach out to them by having pre negotiate rates for treatment when payments are made in advance for certain procedures. Hospital should have system to accept payments when made in any

Governor Greg Abbott vetoed bills passed on the last regular session of the Texas Legislature on June 21, 2015. Three of the bills that had passed legislation, were vetoed by Governor Greg Abbott, the bills are listed as HB 1855, SB 496, and HB 499.

The $3,000 deductible feature means that the insurance will not cover the first $3,000 of eligible expenses for the year (or possibly for each illness or accident in which Zach is involved, depending on the policy terms). The 80% coinsurance clause indicates that the insurer will pay only 80% of the amount of covered losses in excess of the deductible. The internal limit of $180 per day on hospital room and board indicates that the maximum the insurer will pay for hospital room and board is $180 per day. The internal limit of $1,500 on surgical fees indicates that the insurer will pay no more than $1,500 for such expenses.

AI may enroll in a managed care plan (plan) or American Indian Health Program (AIHP)

This letter is in response to your appeal regarding the laboratory tests performed November 13, 2107. As a Grievance and Appeals Coordinator, I reviewed your claim, your appeal, and your health care plan benefits for Blue Cross Blue Shield of Michigan (Blue Cross). After review, I confirmed that payment for the services processed correctly and no additional payment is available. You remain liable for your deductible requirement of $84.60 and the non-covered charges remains a matter between you and the provider.

Fee for service indemnity plans are essentially health insurance plans in which the consumer may choose any provider or hospital that they want to use; however, these plans are typically more expensive than other plans (Mukherji & Fockler, 2014). The fee for service plans pay only for services rendered, typically using the CPT coding system (Reimbursement, 2016). The indemnity plans will require the provider to bill the insurance company for services rendered (Zuvekas & Cohen, 2016). Typically, the insurance company will pick up 80% of the patient’s bill and the patient is responsible for the other 20% (Zuvekas &

Fee-For-Service or Traditional Indemnity plans are uncommon but still used. Payment is rendered for services provided. Traditional Indemnity plans in general have no provider network and a patient can see a specialist without a referral. If a patient uses an FFS plan, the patient would pay the provider for medical care provided. If the medical care provided is covered by the plan. The insurance company would then reimburse the patient according to the guidelines stated in the policy or the UCR’s “Usual, Customary, and Reasonable Fees.” (“Private-Fee-For-Service Plans,” CMS.gov, 3/16/2012). Key benefits of a Traditional Indemnity or Fee-for-Service plan include no in network physicians or health care providers and the patient may see any physician or seek health care services at any healthcare facility. The patient or client can also seek treatment from a specialist without a physician referral. Fee-for-Service plans are the most flexible plans for choosing a healthcare provider and health care facility. However, Traditional Indemnity plans are traditionally the most expensive plans offered by Health Insurance companies to customers. Insurance companies typically will not reimburse one hundred percent of the amount paid out of pocket, deductibles must be met by the patient before co-payment or reimbursements are issued by the insurance company, and the patient is liable for all payments out of pocket until reimbursement is issued.