Federal And State Legislature 's Theory Of Medical Network Laws Essay

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Federal and State Legislature’s Approach to Medical Network Laws

How many times have you heard a provider’s office tell you that you are out-of-networking? “Out-of-Network”, two questions come to play; the first question is what does that mean to a patient and how do insurance companies determine network benefits for their beneficiaries. First, we will define the term “network” is used to describe the providers, that are. “Networking” becomes an issue of patient’s access to providers and the costs associated with seeing a provider outside their insurances’ network. The following are definitions that will be usefully in the discussion of this paper:
1) Member is an individual that holds the benefits of the health insurance. The health benefits that is provided to the member will be outlined in the healthcare insurance plan. The plan will dictate how what healthcare servicers are covered and not covered. The plan also, services as a tool to calculate patient and insurance financial responsibility.
2) Network determination is determined by the health insurance companies that describes which doctors its member can see “in-network”, that will allow for normal plan fees (copays/coins/deductibles) to be incurred by the member. However, if the member chooses to see a provider “out-of-network” then the member is subject to higher fees then if they were to see a provider “in-network”
Health insurance carriers are the entity that offers medical benefits to their beneficiaries.
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