HCR220 CheckPoint_Features of Health Plans

HCR220 CheckPoint_Features of Health Plans - provider is...

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CheckPoint: Features of Health Plans There are many types of medical health plans available however there are only two basic types: indemnity and managed care. Indemnity plans protect against loss. The payer indemnifies the policy holder against cost of medical services and procedures as listed on the benefits schedule. Patients are then able to choose the doctors that they wanted to see. Then the physician sends a claim to the payer on behalf of the patient. Managed care offers a more restricted choice of providers and treatments in exchange for lower premiums, deductibles and other charges than traditional indemnity insurance. MCO’s (managed care organizations) create links between provider, patient, and payer. Instead of the patient having a policy with the health plan, both the patient and the provider have agreements with the MCO. This gives the MCO more control over what services the
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Unformatted text preview: provider is able to perform and the fees for those services. Currently, managed care plans are the most predominant form of insurance. Over 90 percent of all insured employees are enrolled in some type of managed care plan while others are enrolled in health maintenance organizations, point-of-service plans, preferred provider organizations and consumer-directed health plans. Based on the information presented to me about financial coverage, I would have to say that each plan offers some type of financial or coverage benefits to both consumer and provider. Depending on what is more convenient for the consumer or provider, determines which plan would work best for them. Reference Valerius, J., Bayes, N., Newby, C., & Seggern, J. (2008). Medical Insurance: An Integrated Claims Process Approach (3 rd ed.). Boston: McGraw-Hill....
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