HCS 235 Week 2 Completed Health insurance matrix

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).

However, this option has its limitations that make it difficult for the patients to access health care services in many ways. Since it does not fully cover the medication expenses, some patients may get it difficult to cover the remaining expenses. The indemnity insurance has the set limit in which the policy will cover you. If the hospital bills surpass the set level, expenses will go up and it will be your responsibility to pay the remaining expenses. This coverage will not be relevant since it will not have fulfilled your mission for taking a policy.

No one plans to have oneself or a family member diagnosed with a chronic disease or to be involved in a debilitating accident. Unfortunately, these situations are all too familiar and can happen every day. Having health insurance when these life changing events occur can provide a person or family

The policy states that if a patient has a copay or any other payment that needs to be made then he/she should do so at the time of their visit. This is usually done at the end of the visit encase the doctor orders any tests or lab work that might cost the patient more money. Patient’s should be informed of all or any charges and given an estimated cost.

Since the advent of health insurance in the 1950s, there have been many models of care that are come to the scene in an attempt to both control cost of care and improve quality of care. Insurance models came into being because the fee for service model used until then was proving to increase cost of healthcare without any measure of quality of services and care provided. Health insurance models have evolved from the basic hospital offered insurance to employer sponsored coverage plans. The US health system is broken both financially and quality wise with more than 20% of gross domestic product being spent on healthcare (Blackstone, 2016).

As you learn about health care delivery in the United States, it is important to understand the various models of health insurance to develop a working knowledge as you progress through the course. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers as important foundational information for your role as a future health care worker. Fill in the following matrix. Each box must contain responses between 50 and 100 words using complete sentences.

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

Risk of financial ruin is an important factor of having insurance. You Might face some health problems in later months like a sudden accident, cancer, diabetes, kidney stones or a car accident, this will leave with staggering medical bills. And not paying

This paper will include: the current health care expenditures whether spending is too much or not enough, where the nation should add or cut, how the public’s health care needs are paid and provide a forecast for: the future economic needs, why these needs must be addressed, how I envision these needs will be financed and conclusion.

Originally known as “Medicare+Choice,” the new private options offered attractive add-on benefits such as prescription drug coverage for new enrollees.

Physicians and other facilities are paid by insurance companies, including Medicare and Medicaid, based on the procedure (CPT) code they submit. These codes must be accompanied by the correct diagnosis or ICD-10 codes.There must be a valid reason for a medical encounter for the physician to be paid, such as pain, refills for medications, or a follow-up for such diseases as diabetes or any chronic condition. If you just submit the CPT or ICD-10 code separately then you will not be paid as both support each other. So it is vital that a medical biller and coder be aware of these rules and how to complete the claim forms properly.

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 &

This paper will discuss the preexisting condition Insurance Plan Program and its effects on the healthcare and health insurance market as well as the Segway into the elimination of Pre-existing condition clauses for insurances as found in section 2704 of the public health service Act. The remainder of this paper is organized as follows: Section 1 discusses Why the policy was enacted, section 2 discusses the economic environment previous to the PCIPP, section 3 Evidence supporting a market failure in the insurance industry, section 4 discusses how the plan was accepted and how it is working, section 5 discusses future implications, and section 6 discusses the conclusion

Having a primary care provider not only gives you a personal health care organizer but it also reduces your health care cost. According to a research at the University of Missouri, 90 percent of patient’s medical needs can be met by primary care providers in an outpatient setting. Going to a specialist with an issue that you might be uncertain of can be expensive. First of all, the specialist might not have your medical record. The specialist may have no idea about your past medical history, physical examination report and social and family report. This increases your chance of doing screenings that you’ve done in the past which results in unnecessary cost. Instead of blindly going to a specialist, your PCP can make initial diagnoses and decide whether he/she can take care of you at their office or need to refer you to a specialist. PCPs also obtains most of your medical record, they are aware of your circumstances and can help you prevent an illness before it happens. According to doctor McDoniel from Palos Medical Group, “The time, money and amount of medicine needed to treat high blood pressure are a lot less than it is to treat a heart attack.” Having an organized health care plan can eliminate unnecessary costs and increase preventive treatments.

Every patient varies because they have different insurance company's. When it comes to insurance companies there will be ones that will pay for the maximum of the bill and there are ones that will pay the percentage of the bill. There are insurances that patient will pay a copay in which there are patient that will pay less and there be patients that will pay more. I Do believe that the more you make the more the person pay out of pocket and for the ones who pay less it's because they don't make much. I have seen where a patient copay is to about $75.00 dollars and ones that pay $5.00 dollars I would love to have a copay that is $5.00 dollars and that is just to see your primary doctor. There are patient that needs immediate care and the physician