Purchasing and Contracting Health Plan Options Worksheet Part B question 2

Purchasing and Contracting Health Plan Options Worksheet Part B question 2

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Unformatted text preview: 2. 1What are positive and negative ramifications of discounted fee-for-service arrangements? The most significant negative ramifications of discounted Discounted fee-for-service arrangements can have both positive and negative ramifications. The most significant negative ramifications of discounted free-fee-service arrangements is that preventive care is not covered. This really affects the patient more so than the physician, because any unnecessary tests or exams would be out-of—pocket expenses for the patient. There are benefits and disadvantages for not only a physician but also for the patient when it comes to discounted fee-for—service and participation contracts. Another example, of negative ramification of discounted fee-for-service arrangements is that providers receive reduced fee because PPO’s pay them based on a discount from their fee schedules. A positive ramification of discounted fee—for—service arrangements is for patients. If patient insured by PPO uses an in-network-doctor, the patient pays and annual premium, but copayments at the time of service are lower. If patient decides to use out-of—network physician, the amount of the money that the patient will have to pay out-of-pocket will be. Many large companies cover the cost of their employee's medical benefits themselves, instead of buying insurance from other companies. This saves the company money by being self-funded. Self— funded health plans don't have premiums to pay insurance carriers or have a managed care organization. Employers set up benefits and plan types to offer employees. The company‘s self-funded plan may set up their own provider network or lease managed care organization's network. With this plan, you may buy other types of insurance instead of insuring the benefit themselves. Third-party claims administrators are often hired to collect premiums, process and pay claims. Some people purchase their own individuai health plans. According to University of Phoenix Medical Insurance: Integrated claims process approach (Bthed), Ch. 8 (2014)- {Almost 10% of peopte with private health insurance have individual plans.) People that buy their own health insurance are usually between jobs or self-employed. When you leave a job, you are given the option to continue the health insurance coverage under the employer's plan for a short time and you are responsible to pay the full premium. It is very critical for physician look closely at participation contracts and choose what is best for practice. fill.— _.._.. _...J._.l_l_ _...-..._._._ I__.... _..l_l!l.!_.._._l £._£_....___.I.!....._ _.._ ...
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