Insurance case study analysis Health, Medicine, Nursing Coursework (Coursework Sample)
Read the case scenario and answer the case questions:
A patient is confused about how to make payments for a recent visit to urgent care and hospital stay. Her employer-based insurance provider's website allows her to use her HSA account to make a payment online. She uses her HSA debit card to make the payment, but her insurance provider sends her a check instead of sending it to the Tri-City HealthCare Agency. After contacting her insurance help desk via the website, she is told to send the check to Tri-City HealthCare Agency herself. The patient asks the insurance provider's help desk representative why they cannot just make the payments for her. She is told about the various payment types and payers in the health care industry and how the market influences the integrated delivery systems in the industry.
Describe the payer systems mentioned in the case study.
Explain how the market forces have influenced the need for integrated delivery systems.
How might the insurance provider explain the payment system it utilizes for its clients? Explain if this method is effective or not for the insurance provider's clients.
What has been the most significant legal and regulatory effect on managed care organizations?
How would this case study have differed if the patient was using public or social insurance?
The response to each question should be a minimum of 200 words. Formal essay structure is not required; differentiated responses to each question are acceptable.
Integrate two to four scholarly sources in the collective assignment.
Insurance Case Study Analysis
Insurance Case Study Analysis
The Health Savings Account (HSA) mentioned in the case study is based on a health insurance plan with a tax-advantaged account to help reduce medical expenses for patients who are supported by the high-deductible health plans (HDHPS). Accordingly, an individual who utilizes the HSA services can make contributions themselves or through their employer-based on an annual fixed maximum amount. The contributions are then invested over time and can be used to pay for qualified medical services like dental care and vision treatment, or purchase of over the counter medicine. It follows that an individual only pays a portion of the claim they are responsible for. The insurance company covers the remaining portion, which is typically 80%-90% based on specifications in the contract.
As already mentioned, an individual with HDHPS may qualify for the HSA. The individual who qualifies for HDHPS is paired with an HSA; then, its services are offered by a health insurance provider. Numerous financial institutions can also open an HSA. Other items in the eligibility criteria are set out by the Internal Revenue Service (IRS). They include an individual having no additional health coverage, not listed as a
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