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sometimes a pre-authorization (a method to review the referral) is required to ensure the visit to aspecialist is appropriate and medically necessary before approving or denying the referral. A2C. Coverage for Preexisting ConditionsIn Japan it is illegal for an insurance company to refuse payment of care due to preexisting conditions. Whereas in the USA, all Marketplace insurance plans must cover treatment and are not allowed to charge more based on health as well with the exception for the grandfathered plans, which are health insurance policies purchased on or before March 23, 2010,when the PPACA was formed (“Coverage for pre-existing conditions,” n.d.). The solution to thisUpdated on 2/21/19
ORGANIZATIONAL SYSTEMS TASK 3 4problem it is for the insured person to switch to a new plan that is offered through the Marketplace where the new laws apply. A3. Finance Implications for Healthcare DeliveryThe main finance implication for healthcare delivery when comparing Japan to the United States is the cost. In Japan, the cost of healthcare is so unexpensive that doctors and hospitals are at risk of going bankrupt and is unheard of any patient going bankrupt due to medical bills (Palfreman, 2008). In the meantime, Americans are struggling to maintain healthcare access affordable and many individuals go bankrupt due to medical expenses being sohigh. Unfortunately, the uninsured and underinsured continue to access healthcare and leave