Modern Claim Summary

The second problem: insurers are beginning to hold healthcare facilities financially responsible for never events (Ozan-Rafferty). As a result, physicians and hospitals have to pay for the care they provided, in addition to the errors that they encountered. If the insurers do this, it would bring the downfall of the entire hospital because there would be so much expenses that the healthcare facilities have to pay that it may not be able to pay for most of the debts that they have in the facilities.

The United States healthcare industry is facing some serious long-term issues. The number of uninsured people is in millions.

More and more people with medical insurance are relying on the health care system as new technologies and treatments become available. This leads to a grater number of claims for payment by insurance companies, the costs of which are passed back to health care consumers. The baby-boom generation is entering its peak health-care using period. Over eighty million Americans will turn 50 in the next 10 years. The cost of providing heath care for these individuals will be staggering

Health care expenses are a never ending headache that create numerous liabilities. Liabilities are created when goods or services are purchased on credit and obtained through short- term and long- term loans. Health care expenses create liabilities such that payments are made late or no payments are made at all. In some cases, the cost of health care expenses are unaffordable resulting in those type of payments. To prevent large health care debt, many individuals seek health insurance. Health insurance is provided by private insurance companies or by the government. It covers health care expenses and provides the necessary health care. Although, health insurance is necessary it can also be very costly.

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.

Employers are continuing to face rising health benefit costs and are constantly looking for alternatives to control these escalating costs. Health benefit premiums continue to increase at a double digit pace for employers and employees (Poor, Ross & Tollen, 2004). This escalation is putting environmental pressures on all impacted stakeholders. Companies and insurance providers are squeezing this industry to get a handle on cost while still providing an appropriate level of care. This cycle puts the patient front and center as the ultimate stakeholder who incurs changes in health benefits. This mandate of cost control, efficient operations and market share has facilitated a constant analysis of the dynamic health

H. (04/2015). Comprehensive Health Insurance: Billing, Coding & Reimbursement, VitalSource for Allen School of Health Sciences, 1st Edition. [Bookshelf Online]. Retrieved from https://online.vitalsource.com/#/books/9781323131503/

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. Should the information pertaining to actual claims incurred as of the balance sheet date that became available after the balance sheet date be considered in determining management’s best estimate of the medical benefits payable? If so, how does this information impact the amount recognized or disclosed?

Insurance is a critical part in the health care of Americans that would use it for life threatening, unaffordable and spontaneous health issues. But instead insurance has created substantial problem because it is being utilized as a payment system for everyday primary health care and not to cure

In America, we not only have the problem of the non-insured but the under insured which causes just about as much problem as the underinsured. Each group has contributed to the vast growing cost of healthcare. Over the last decade or two, the amount of uninsured has risen due to the job market in the economy and the fact that most insurances are tied to employment, which is also a problem as the unemployment rate rises. The purpose of this paper is to explore this issue.

The complexity of health care could take the rates on a massive trajectory that does not favor the people covered. Therefore, the financial protection that the levels of health insurance covers, help to guard against the risks related to the unexpected costs of health care. The source of coverage could still have an impact by the insurance coverage and financing alternatives that one has access to; Conversely, private insurance, social insurance, and the national health services are the types of healthcare systems by funding and provision. As we look to health care coverage and the reform of Obamacare, I’ll analyze the impact of the uninsured in the industry and look for a resolution to improve the

The three principle parties involved in the U.S. Healthcare system are the consumer, provider and insurer. The provider includes the hospitals, clinics, doctors, nurses and pharmacies that provides a service; the consumer is the individual who receives the medical service and supplies the money; and the insurer is a third party intermediary between the provider and the consumer which accept money from a pool of consumers and reimburse the providers. Like any transaction, there is a certain degree of risk associated for members of the different parties. This risk is based upon variables within the U.S. healthcare model including the method of, and who is reimbursing the providers.

Gapenski, L. (2006). Healthcare Finance (4th Ed.). Retrieved from The University of Phoenix eBook Collection database.