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).

There are several types of private payer plans including preferred provider organizations (PPO’s), health maintenance organizations (HMO’s), and point of service (POS). Indemnity plans would cost the most for employees and they usually choose a PPO plan. A trend that is gaining popularity with employees and employers is the consumer driven health plan (CDHP) that has a high deductable combined with a funding option of some type. All of the plans have unique features for coverage of services and financial responsibility.

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.

A health insurance plan pays for medical care only after the insured has first paid $500 out of pocket on an annual basis. The $500 annual cost is called

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.

1). Private health insurance is another way of paying for health care. The associated costs of health care are offset according to the policy the person has purchased. Private health insurance costs are paid by premiums, deductibles, and co-payments from the insured person. There is also the portion of people who are uninsured and are considered self-pay patients. These uninsured patients represent a large part of unpaid services. Although, not all uninsured patients leave bills to be absorbed by the health care system many do, and this increases the costs of health care to be absorbed in other areas.

Plan A’s plan type is an indemnity, this means that you have freedom to choose your doctors and hospitals and then pays a set part of your charges. Plan B is a network plan type, this means that you need to use the doctors and hospitals in their network to receive the highest amount back.

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

They also have to pay a deductible, a certain amount of money that the individual (also referred to as ‘the insured’) must pay before an insurance company will pay a portion of their medical expenses (or ‘claim’), when they choose an insurance company. Healthcare coverage is the amount of protection given by the insurance company.

It is composed of its members, plans, payments and providers. The members make up the patients, and every patient has their own "benefits" when it comes to healthcare coverage. Each person's "benefits" varies widely. What it typically means is that the health plan provides coverage for certain types of medical procedures, services and goods. This coverage is provided only under certain circumstances described in the plan. The payments are made by "payers," which manage the "benefits" for healthcare procedures, services, and goods. Basically, what procedures, services, and goods will be paid for, how much they will pay for it, when their "benefits" cover it, and how much the patient will have to pay out of pocket. As for the different types of payers, they range widely from health maintenance organizations (HMOs), preferred provider organizations (PPOs) and managed care organization (MCOs). These types of payers can also be not for profit, for-profit, or member owned. Last is the providers, these are the people and/or manufacturers who perform the services and/or procedures for the patients. The providers then contact the patient’s insurance holders to receive payment for their services. Besides members, plans, payments, and providers, managed care is also composed of manufacturers. They manufacture the pharmaceuticals used, as well as the medical devices. When

|Indemnity Plan |Able to choose hospital and doctor, Fee for service, deductible, |Individuals and Families |

Two simple questions, without a simple answer to either. In this paper were going to try and answer these questions and a few other important questions about the healthcare system in our country.

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 &

National Health Care System benefits employers by lowering their current health care costs. Companies need the National Health Care System now more