Loading...

Messages

Proposals

Stuck in your homework and missing deadline? Get urgent help in $10/Page with 24 hours deadline

Get Urgent Writing Help In Your Essays, Assignments, Homeworks, Dissertation, Thesis Or Coursework & Achieve A+ Grades.

Privacy Guaranteed - 100% Plagiarism Free Writing - Free Turnitin Report - Professional And Experienced Writers - 24/7 Online Support

Pso health insurance

01/01/2021 Client: saad24vbs Deadline: 24 Hours


Health Insurance Matrix


HCS/235 Version 7


1


Health Insurance Matrix


As you learn about health care delivery in the United States, it is necessary to understand the various models of health insurance to develop important foundational knowledge as you progress through the course and for your role as a future health care worker. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers. Fill in the following matrix. Each box must contain responses between 50 and 100 words and use complete sentences.


Model


Describe the model


How is the care paid or financed when this model is used?


What is the structure behind this model? Is it a gatekeeper, open-access, or combination of both?


What are the benefits for providers in using this model?


What are the challenges for providers in using this model?


Health Maintenance Organization (HMO)


. A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.


Health maintenance organizations represent “pre-paid” or “capitated” insurance plans in which individuals or their employers pay a fixed monthly fee for services instead of a separate charge for each visit or service. The monthly fees remain the same, regardless of types or levels of services provided. Services are provided by physicians who are employed by, or under contract with, the HMO.


You’ll select a Primary Care Physician who will be the first point of contact for your healthcare. You are encouraged to build a strong relationship with your PCP because they will connect you to specialists or other health care providers. Your PCP will be able to see the total picture of your overall health.


With an HMO plan, your out-of-pocket medical costs and monthly premiums will generally be lower than with other types of plans. If you are someone who doesn’t see a lot of specialists or would like having your care coordinated through a PCP, then you might save more money with an HMO plan.


Tight controls can make it more difficult to get specialized care


As an HMO member, you must choose a primary care physician (PCP). Your PCP provides your general medical care and must be consulted before you seek care from another physician or specialist. This screening process helps to reduce costs both for the HMO and for HMO members, but it can also lead to complications if your PCP doesn't provide the referral you need


Preferred Provider Model


. A Medicare PPO Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. In a PPO Plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network . You pay more if you use doctors, hospitals, and providers outside of the network


Rather than prepaying for medical care, PPO members pay for services as they are rendered. The PPO sponsor (employer or insurance company) generally reimburses the member for the cost of the treatment, less any co-payment percentage. In some cases, the physician may submit the bill directly to the insurance company for payment. The insurer then pays the covered amount directly to the healthcare provider, and the member pays his or her co-payment amount. The price for each type of service is negotiated in advance by the healthcare providers and the PPO sponsor(s).


Free choice of healthcare provider


PPO members are not required to seek care from PPO physicians. However, there is generally strong financial incentive to do so. For example, members may receive 90% reimbursement for care obtained from network physicians but only 60% for non-network treatment. In order to avoid paying an additional 30% out of their own pockets, most PPO members choose to receive their healthcare within the PPO network.


Out-of-pocket costs generally limited


Healthcare costs paid out of your own pocket (e.g., deductibles and co-payments) are limited. Typically, out-of-pocket costs for network care are limited to $1,200 for individuals and $2,100 for families. Out-of-pocket costs for non-network treatment are typically capped at $2,000 for individuals and $3,500 for families. And they have a free choice of healthcare provider.


More paperwork and expenses than HMOs


As a PPO member, you may have to fill out paperwork in order to be reimbursed for your medical treatment. Additionally, most PPOs have larger co-payment amounts than HMOs, and you may be required to meet a deductible. Less coverage for treatment provided by non-PPO physicians


As mentioned previously, there is a strong financial incentive to use PPO network physicians.


Point-of-Service Model


A Point of Service (POS) plan is a type of managed healthcare system that combines characteristics of the HMO and the PPO. Like an HMO, you pay no deductible and usually only a minimal co-payment when you use a healthcare provider within your network. You also must choose a primary care physician who is responsible for all referrals within the POS network. If you choose to go outside the network for healthcare, POS coverage functions more like a PPO.


No "gatekeeper" for non-network care


If you choose to go outside the POS network for treatment, you are free to see any doctor or specialist you choose without first consulting your primary care physician (PCP). Of course, you will pay substantially more out-of-pocket charges for non-network care.


POS coverage allows you to maximize your freedom of choice. Like a PPO, you can mix the types of care you receive. There is no minimal co-payment. Also when you choose to use network providers, there is generally no deductible. As well as no healthcare cost paid out of your own pocket


Substantial co-payment for non-network care


As in a PPO, there is generally strong financial incentive to use POS network physicians. For example, your co-payment may be only $10 for care obtained from network physicians, but you could be responsible for up to 40% of the cost of treatment provided by non-network doctors. Thus, if your longtime family doctor is outside of the POS network, you may choose to continue seeing her, but it will cost you more.


Provider Sponsored Organization


A Provider-Sponsored Organization (PSO) is a type of managed care plan that is operated by a group of doctors and hospitals that form a network of providers within which you must stay to receive coverage for your care. People with Medicare can choose to get their Medicare benefits through a PSO.


PSO receives a fixed monthly payment to provide care for Medicare beneficiaries. PSOs may be developed as for-profit or not-for-profit entities of which at least 51 percent must be owned and governed by health care providers (physicians, hospitals or allied health professionals). PSOs may be organized as either public or private entities


The gatekeeper would be Medicare in the United States can be defined as ' A group of doctors, hospitals, and other health care providers that agree to give health care to Medicare beneficiaries for a set amount of money from Medicare every month. This type of managed care plan is run by the doctors and providers themselves, and not by an insurance company


High Deductible Health Plans and Savings Options


A health savings account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (HDHP). The funds contributed to an account are not subject to federal income tax at the time of deposit.


You have the freedom to see any health care provider, including specialists, without a referral, although you will save money if you see in-network providers. This is especially important since instead of a copay, you will be paying the full cost of a doctor’s visit or service until you satisfy your deductible


Others can contribute to your HSA. Contributions can come from various sources, including you, your employer, a relative and anyone else who wants to add to your HSA. High deductible plans also allow you to meet health plan stipulations that your community may have. By having yourself and your family covered with health insurance, you can be in compliance with specific laws that require insurance coverage.


You have high deductible requirement. Even though you are paying less in premiums each month, it can be difficult – even with money in an HSA – to come up with the cash to meet a high deductible.


You have unexpected healthcare costs. Your healthcare costs could exceed what you had planned for, and you may not have enough money saved in your HSA to cover expenses.


Cite your sources below. For additional information on how to properly cite your sources check out the Reference and Citation Generator resource in the Center for Writing Excellence.


References


Copyright © 2016 by University of Phoenix. All rights reserved.

Homework is Completed By:

Writer Writer Name Amount Client Comments & Rating
Instant Homework Helper

ONLINE

Instant Homework Helper

$36

She helped me in last minute in a very reasonable price. She is a lifesaver, I got A+ grade in my homework, I will surely hire her again for my next assignments, Thumbs Up!

Order & Get This Solution Within 3 Hours in $25/Page

Custom Original Solution And Get A+ Grades

  • 100% Plagiarism Free
  • Proper APA/MLA/Harvard Referencing
  • Delivery in 3 Hours After Placing Order
  • Free Turnitin Report
  • Unlimited Revisions
  • Privacy Guaranteed

Order & Get This Solution Within 6 Hours in $20/Page

Custom Original Solution And Get A+ Grades

  • 100% Plagiarism Free
  • Proper APA/MLA/Harvard Referencing
  • Delivery in 6 Hours After Placing Order
  • Free Turnitin Report
  • Unlimited Revisions
  • Privacy Guaranteed

Order & Get This Solution Within 12 Hours in $15/Page

Custom Original Solution And Get A+ Grades

  • 100% Plagiarism Free
  • Proper APA/MLA/Harvard Referencing
  • Delivery in 12 Hours After Placing Order
  • Free Turnitin Report
  • Unlimited Revisions
  • Privacy Guaranteed

6 writers have sent their proposals to do this homework:

Helping Hand
University Coursework Help
Top Essay Tutor
Writer Writer Name Offer Chat
Helping Hand

ONLINE

Helping Hand

I am an Academic writer with 10 years of experience. As an Academic writer, my aim is to generate unique content without Plagiarism as per the client’s requirements.

$35 Chat With Writer
University Coursework Help

ONLINE

University Coursework Help

Hi dear, I am ready to do your homework in a reasonable price.

$37 Chat With Writer
Top Essay Tutor

ONLINE

Top Essay Tutor

I have more than 12 years of experience in managing online classes, exams, and quizzes on different websites like; Connect, McGraw-Hill, and Blackboard. I always provide a guarantee to my clients for their grades.

$40 Chat With Writer

Let our expert academic writers to help you in achieving a+ grades in your homework, assignment, quiz or exam.

Similar Homework Questions

In regression analysis the residuals represent the - Oprah winfrey harvard commencement speech transcript - Echoing green poem summary - Costco case study crafting and executing strategy - Webassign college algebra answer key - 3820 presentation - Flower part crossword clue - Why dolphin jumps out of the water - Unlevered cost of capital - Nursing question - Module 4 Writing assignment - Monash residential services email - Number of triangles in a dodecagon - Accumulator tank pressure setting - A plus algebra 1 answers - Mathswatch worksheet answers gcse - Student project report sample - X squared times x cubed - Class d lc filter design - Cpt code for antrectomy - Do metals tend to form positive ions - An engineer has received two bids for an elevator - Casl 2 subtest descriptions - Cloud Computing - Cultural approach to organizations - Macbeth act 2 quotes quiz - Subnetting math problems - How to write a periodization essay - Ron williamson good morning america - Forced leave policy csc - Steps of the closing process in the right order - Aem boost gauge 30 4406 install - Zukureview question of the day - Human resources management / organizational behaviour - The diagram shows a zn mno2 koh alkaline dry cell - Lakes in victoria for boating - Applied Statistics - Echelon ncly pty ltd - Pedagogy of the oppressed chapter summary - Things i'm grateful for - Police administration 9th edition pdf - If bagels and doughnuts are substitutes, then a decrease in the price of doughnuts will result in - Partenavia p68c flight manual - Internal locus of control - Pine street family practice - Waves and vibrations lab - Accounting: Week Eleven Discussion For the week eleven discussion board I would like you to take a look at a company website of your choice. - What is the depth of a fathom - You are in charge of shipping computers to customers - Calculating tidal volume by weight - Fishy in the water fishy in the sea lyrics - Chapter 13 the expenditure cycle purchasing to cash disbursements - Nursing theory utilization and application - What does valdez mean in english - Penélope muestra sus fotos a mí. - Adelaide university football club results - Who determines ethical standards for advertising fast food - The no show consultant case study - Bpw hub cap socket - 108 names of lakshmi - Eva almer forever i am all yours lyrics - Personal statement for data analytics - Sales mix in units formula - Duke university campus life - 68 teeth by james moloney - Mastering ohio's american government assessment answers chapter 7 - Chapter 7 case study answers - Lester horton modern dance pioneer - Cloud Computing - knowledge, skills, or theories of this course have been applied, or could be applied, in a practical manner to your current work environment. - Titration khp with naoh equation - Bore log report for soil investigation - Ball bearings inc faces costs of production as follows - Murder in amsterdam ian buruma sparknotes - Www keiserlibrary com - Gorilla playing drums advert - D5 - Questions 1: Classes and Pointers - Free tr 069 server - Chemical regulation of respiration - When i heard the learn d astronomer analysis - 12/70 park street st kilda west - Candy thermometer temperature range - Mylms ack - Mgmt 404 week 4 course project - What is data inconsistency - Case analysis - Electron configuration lab data sheet 1 answers - Characters in oliver twist - 2015 vce methods exam 2 - Personal Leadership Philosophies - Vera bradley trunk show 2019 - Stream england vs new zealand rugby - Digital electronics principles and applications 8th edition - Identify the four challenges associated with e business - What is the conjugate base of nh4 - Experiment 1 heart valves and pumps - Community m4a2 - North west leadership academy - HR: Post and responses - Nouadhibou ship graveyard google maps