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: 12 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:

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

$105 Chat With Writer
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.

$100 Chat With Writer
University Coursework Help

ONLINE

University Coursework Help

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

$102 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

Chcdiv001 answers - Is wayne williams still in jail - Case Study Milestone Two: Short Paper Assignment - Now and Then: History of Early Childhood - Standing order form template charity - Mad dogs englishmen and the errant anthropologist pdf - Texas reality check worksheet - Which sentence contains repetitious words that should be left out - Approaches to psychology worksheet answers - I need this homework by tomorrow afternoon - She got them brown eyes - As 4811 employment screening - Umuc math 107 final exam answers - Making ethical decisions evaluation answers - Esther park shadow health diagnosis - Wisdom sits in places chapter 4 summary - Brothers and sisters i have none riddle answer - Lawns unlimited is a lawn care and maintenance company - Image 15.0 r treadmill walmart - Suonerie per gli Amanti del Teatro: Suoni Drammatici per Artisti - Expected return of combined portfolio - Skill related components of fitness - Dalston junction tube map - Biggest internal organ in the body - Table of common ions - Unit2 db INTD 670 - Blog/twitter post assignment - Wk 1, HCS/370: DQ - Volts per hertz generator protection - Dulux powder coat bronze - Nova hunting the elements worksheet answers fill in the blank - Law - Tax identification number spain example - Farnell in one belgium - Hampshire street lighting faults - Mr mrs miss ms - Descended from odin trustpilot - Aa big book pg 84 - Ikea riyadh opening hours during ramadan - Cristiano ronaldo characteristics - Department supervisor job description - Discussion needed by 3pm Sat - Name two principal types of cost accounting systems - Mbs bookstore umuc - Assignment 1 identify musical ideas - Teacher aide relief work - Go-To-Market - Chapter 2 business ethics and social responsibility ferrell - In mice the ability to run normally is a dominant trait - Agent based software development - Army blc sharp essay - B1134 side module lh open - Salters nuffield advanced biology activity answers - Solve the equation 5d 17.1 - How to prepare acidified potassium permanganate solution - Academic Paper #2, 600-800 words - Champion spark plug cross reference small engine - Parliamentary education office website - Dsm 5 cross cutting symptom measure - Westjet airlines information technology governance and corporate strategy - Aussie disposals ski pants - Week 7 Case Study- Carlson Companies - Circumcircle of a triangle properties - Dress code for endoscopy - En 61000 6 2 - Counseling therapy treatment plan template - Bayonne packaging case study solution - On seeing england for the first time essay - Microsoft access chapter 1 - Commitment a cautionary tale and provide an example - Japanese segregation in san francisco answer key - Este restaurante sirve más cincuenta platos tradicionales. ¡tienes que venir a probar alguno! - Is h2o an ambidentate ligand - Yarrows frozen dough australia - How to draw price elasticity of demand curve in excel - Discussion: Discuss and Debate - Assignment 2.1: Personal SWOT Analysis - Management information system.For this project, use the following hypothetical situation - Long term investment decision in financial management - Charlotte is a psychologist who believes in the following statement - 350 words - Fire evacuation drill record - Which of the following statements about price is true - Wisc v ranges - Economics 2 - Australian fitness industry report 2012 - Basic Python and Numpy Coding - How did islam change the way ghazu worked - Jim houghton northwestern mutual - Physical security failed - 2973 kj to calories - Critical reasoning week 5 Assignment - Grasslin mechanical timer instructions manual - Experiment 2 effect of chemical germicides on bacterial growth - Samsung wacc - Environmental science model answers - Is slavery an abstract noun - How to measure the speed of light using a microwave - Cloud computing - Cell biology simulation software