Examining Healthcare Reimbursement Systems

Examining healthcare Reimbursement systems
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Examining healthcare Reimbursement systems
Part A: The components various insurance plans
Fee-for-service (indemnity) plans
Indemnity Insurance plans refer to a health coverage policy offering a relaxed option in choosing doctors and hospitals. The patients are free to choose any doctor of their choice and are allowed to the change of doctors at any time (Mello, Chandra, Gawande & Studdert 2010). Individuals with indemnity care plans may not necessarily need a referral letter to seek medical attention from specialist or x-rays services. However, any medical records from registered primary care physician can be used. Indemnity insurance plans are responsible for the part of the total bills while the patients are required to clear the remaining bills. The other component of the indemnity insurance plans is deductibles. The latter is referred to a number of the covered bills which the patients have to pay before getting reimbursement from the plan. This amount may starts from $ 100 to $ 300 (Mello, et al., 2010).
Managed Care Plans.
This is the most common insurance plan in America. It covers a wide range of health services. In the event that the patients use doctors who are participating in the plan, then the cost becomes lower (Guterman & Dobson, 1986). Managed care plans have got copay of $10 to $20 meant for the office visit in every time the patient seeks medical attention. However, the copay may vary depending on the healthcare providers attended to and the brand of drugs. The other component of the managed care plans is formulary which refers to a list of drugs covered in the policy. Finally, the mail-order pharmacy option is the last component of the managed care plan (Little, McMahon, Gingrich, & Martin, 1994). In the mail-order option, the patients may decide to send the doctor's prescription purposely for routine maintenance medications to the mail order pharmacy.
Government-sponsored health plans
This is a health care plan sponsored by either state or the federal government. The plan can either be Medicare, Medicaid among others. For instance, Medicare plans provide medical protection to disabled individuals or aged populations covered by Social Security (Guterman & Dobson, 1986). The plan provides affordable cost of care and treatment to this vulnerable category of people. It is partial thus does not cover the entire cost. Consequently, Medicaid plans provide healthcare assistance to low income and blind individuals. The needy families with dependent children may also benefit from the plans. The plans are jointly operated by states and the federal government in aid of Social Security program (Guterman & Dobson, 1986).
High-deductible health plans/healthcare savings accounts
This plan is similar in function to a bank account though it is dedicated to health care expenses. In case the patient does not use all the money in the account, then it rolls over to next year. The insurance plan offers a low monthly premium in exchange for a high deductible and out-of-pocket expenses (Kaplan & Porter, 2011).
Part B; The restrictions in each of the following insurance plans
Free-for-service ...