HCS 235 University of Phoenix Week 5 Health Care Delivery In The US Discussion
HCS/235: Health Care Delivery In The U. S.
Wk4 Discussion – Types of Health Care Insurance
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Financial and Health Insurance Matrix
Understanding the various models of health insurance in the U.S. is essential in helping you develop foundational health care knowledge as you progress through the course and for your future role as a health care employee. The following matrix is designed to help you understand how health care is financed and how health insurance influences patients and providers.
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Complete the matrix. In each box, describe the model in your own words. Ensure that your response is between 150 and 300 words. Consider the following as you complete the matrix:
- How is the care paid or financed when this model is used?
- What is the structure behind this model? Is it a gatekeeper, open-access, or combination of both?
- What are the benefits for providers who use this model?
- What are the challenges for providers who use this model?
Model Describe the model in your own words (150 to 300 words for each response). Health Maintenance Organization (HMO) Preferred Provider Model Point-of-Service Model Provider-Sponsored Organization High-Deductible Health Plans and Savings Options -
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HCS/235: Health Care Delivery In The U. S.
Wk4 Discussion – Types of Health Care Insurance
Discussion Topic
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Post 2 replies to classmates or your faculty member. Be constructive and professional.
1st post to respond to
Jennifer Kidd
19 hours ago, at 3:15 PM
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Hello Everybody 🙂
- Why is it important for health care managers to understand the types of insurance available to consumers? Provide examples.
It is important that health care managers understand the types of insurance in order to know what the patients benefits are in order to pay for the patients visits. As a health care manager you must have that information ready for when it is time to speak with the patients about there treatments or procedures. For example, at my office we are to verify the patients information ahead of time that way once we know what the patients need we are able to send out any information that may be needed to the insurance so that they help pay for the patients procedures.
- Which types are you most and least familiar with? Explain.
I am mostly familiar with Medicaid, Chip and PPO insurance. I am in the dental field so we have to send predeterminations before we do certain major treatments. Sometimes the doctors have to write narratives in order to make sure that the insurance will pay. Sometimes it is hard to get them to help if you don’t provide the correct information such as the proper X-rays and why the dentist recommends the type of treatments or even the deep cleanings.
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2nd post to respond to
Jessica Cobb
17 hours ago, at 5:26 PM
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As a healthcare manager it is important to have an understanding of the different types of insurance providers and have an understanding of the reimbursement they offer for different services provided. For example in a skilled nursing setting the discharge begins the moment they patient is admitted. Understanding what the insurance company will and will not pay for will help determine the care that can and can not be provided. Many insurance companies will negotiate with the healthcare entity about what they are willing to pay for services. The insurance company I am most familiar with is Medicare. The reason for this is because I work in senior living. I am not as fluent with insurances as I would like. The main reason for this is because the part of senior living I work in is a cash only community, we do not accept insurances for payment. However I do assist with long term care insurance and reimbursement for my residents and their families. In our community we have someone who specializes in insurance and their reimbursement rates. Many times we turn to this individual with any insurance questions.
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Assignment Content
Complete the Financial and Health Insurance Matrix. (see 2nd attachment)
Cite any references to support your assignment.
Format your assignment according to APA guidelines.
Submit your assignment.
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