...was put into place to make it possible for everyone to be eligible for health insurance regardless of their pre-existing condition. This paper will be going into details discussing the biggest weakness of the new healthcare law according to the provider and the patient perspective. Also examples will be given why the providers and patient think that this is the biggest weakness of the healthcare plan. While there are many benefits that the legislation thinks that the healthcare reform has, it also has many trails, and adjustments that result from the healthcare administration help originate themselves. There are several major changes resulting from the legislation itself according to research and they are increasing the demand for primary care, demanding that all employers with at least 50 or more employers offer healthcare insurance and be reliable for at least 60% of the benefit cost, and insure them regardless of pre-existing condition, free preventive care for all those that receive Medicare, and also allowing young adults to remain on their parents insurance until they reach the age of twenty-six (Rice, S. 2010). Also it is said due to the increase of primary care, it is always going to be a problem of finding primary care providers to assist patients, and this problem is said to come into existing, because of the preventive services and insurers are trying to find primary physician to be primary physician for patients that don’t have one, and their patient load begin to...
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...Identify and describe the three main types of health insurance in the U.S. Voluntary (Public) Health Insurance: This is provided through one’s employment. There are three sub categories: Blue Cross and Blue Shield, private insurance companies and health maintenance organizations. According to the text, “the respective sponsorships of these types may be providers, third parties, and patients or independent carriers”. Social Health Insurance: Associated with previous employment. Two types programs are Workers Compensation and Medicare. Workers Compensation are benefits paid to an employee during a time when he or she is unable to work because of a work related injury. These benefits include cash payments to replace a paycheck and medical coverage. There is an exchange between the employee & employer for this; the employee gives up the right to take legal action against the employer and the employer accepts liability for the injury. Medicare is benefits for the elderly, disabled, or other qualified individuals (only Part A would fall under this category). Public Assistance: This is geared to individuals and families with little or no income. Each state varies in who qualifies and how benefits are applied. In Pennsylvania, one of their goals is to “improve and sustain the quality of family life”. Various health services such as Autism Services, Mental Health Services, and Attendant Care are available to Pennsylvania residents. In Pennsylvania, one of their goals is to “improve...
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...health insurance reforms that will roll out over four years and beyond. Use the links below to learn about what’s changing and when: OVERVIEW OF THE HEALTH CARE LAW 2010: A new Patient's Bill of Rights goes into effect, protecting consumers from the worst abuses of the insurance industry. Cost-free preventive services begin for many Americans. See More 2010 Changes. 2011: People with Medicare can get key preventive services for free, and also receive a 50% discount on brand-name drugs in the Medicare “donut hole.” See More 2011 Changes. 2012: Accountable Care Organizations and other programs help doctors and health care providers work together to deliver better care. See More 2012 Changes. 2013: Open enrollment in the Health Insurance Marketplace begins on October 1st. See More 2013 Changes. 2014: All Americans will have access to affordable health insurance options. The Marketplace allows individuals and small businesses to compare health plans on a level playing field. Middle and low-income families will get tax credits that cover a significant portion of the cost of coverage. And the Medicaid program will be expanded to cover more low-income Americans. All together, these reforms mean that millions of people who were previously uninsured will gain coverage, thanks to the Affordable Care Act. See More 2014 Changes. 2010 NEW CONSUMER PROTECTIONS • Putting Information for Consumers Online. The law provides for where consumers can compare health insurance coverage...
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...AND STRUCTURING HEALTH CARE Financing and Structuring Health Care Health Services Organization- HSA 500 December 15, 2011 Identify and describe the three main types of health insurance in the U.S. The three main types of health insurance are: * Voluntary Health Insurance * Social Health Insurance * Welfare Health Care According to the authors of our textbook (Williams & Torrens, 2010) “Voluntary or private health insurance in the United States can be subdivided into three distinct categories: (1) Blue Cross and Blue Shield, (2) private or commercial insurance companies, and (3) health maintenance organizations” (p. 82). Initially, Blue Cross and Blue Shield were two separate entities. Before merging in the early eighties, Blue Cross provided coverage for hospital services and Blue Shield covered physician services only. The companies under the Blue Cross and Blue Shield umbrella are licensees and operate independently of each other but all offer plans within specific areas of the country. Private or commercial insurance companies are those that provide health benefits to groups or individuals which are paid for by other parties (ex: employers, employees, unions, etc.) besides the United States government. This particular type of insurance can vary in cost and the benefits received; it all depends upon who is paying and what they are willing to cover. Health Maintenance Organizations (HMOs) are companies that manage the care between the insured and health...
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...Final Sales Paper MRKT 412-02 October 27th, 2015 A. Sales Call Objectives PRIMARY OBJECTIVE: To sell Graham Tire of Fairmont property and casualty insurance for their business. ALTERNATIVE OBJECTIVE 1: To get Graham Tire to agree to a second meeting to have a detailed proposal presented to top management that makes the buying decisions for the company. ALTERNATIVE OBJECTIVE 2: To establish a good connection with Graham Tire associates and follow up with Graham in the future, with the objective of a future sale. B. Company and Product Information Company: Federated Insurance Federated Insurance offers insurance to a variety of businesses. Property and casualty, life insurance, and group health are primary services Federated provides. Federated is based out of Owatonna, MN and are a nationwide company. Product Line: Insurance Product: Property and casualty, life insurance, business insurance Package Contents: Dependent on the specific business and what needs they have. The proposal will be for property and causality insurance for this role-play example. C. Customer Profile Company: Graham Tire This company offers a range of services dealing with motorized vehicles and care of these vehicles. This company has a large inventory of tires and owns tools to complete services on all types of vehicles. Graham Tire specializes in cars, trucks, and tractors. Goodyear tires are primarily carried at this business. Purchasing...
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...contributors to the rising cost of Healthcare can be attributed to the over use of emergency departments (EDs) for non-emergency needs. In the greater Capitol/First/Beacon Hill area there are three major hospitals (Virginia Mason, Harborview, and Swedish) with emergency rooms and no urgent care centers with the exception of Group Health which is restricted to Group Health insurance members. The question I asked myself is, “Why does Group Health have urgent care for their insurance plan members and the major hospitals in Seattle do not.” Urgent vs. Emergency Care A study by the CDC showed that approximately 70 % of emergency department visits can be treated in a typical primary care or urgent care setting and another study by National Center for Policy Analysis demonstrated that only 13% of patients that sought treatment in the emergency department were clinically appropriate. Reasons for non-emergency visits to the ED range from access issues to primary care providers (wait times, no primary care provider assigned, or no insurance) to a lack of knowledge that they could have been treated at an urgent care or primary care setting. There are good reasons to visit the emergency department: * Trauma due to an accident or assault | * A wound that will not stop bleeding | * Shortness of breath | * Vomiting blood | * Chest pain | * Sudden loss of consciousness | For true emergencies the market is very inelastic, patients will spend whatever it takes to...
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...Call insurance company to verify insurance eligibility and benefit status. The patient's eligibility for the insurance plan and the benefits of the plan need to be verified and clarified before the patient is given the initial appointment. How this check is performed will depend on the health care provider status as either primary care physician or health care specialist. A primary care physician (PCP) is a family practitioner, internist, pediatrician, and in some insurance plans, a gynecologist, responsible for providing all routine primary health care for the patient. Call the insurance company to check on the patient's...
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...Cigna was formed by the 1982 merger of the Connecticut General Life Insurance Company (CG) and INA Corporation ( the parent corporation of Insurance Company of North America), the first stock insurance company in America. Insurance Company of North America was formed in 1792, and is known as a corporate ancestor of Cigna. Cigna is one of the largest health insurance providers in the United States, providing health insurance solutions for businesses, families, and individuals. Currently employing more than 30,000 people. Offering insurance products in 27 countries and jurisdictions. Cigna provides medical, dental, vision, accident, pharmacy, behavioral care, life, and disability insurance. Most business is concentrated in large and also small group insurance, where the employee is able to obtain insurance through their employers. However Cigna also offers insurance products to individuals and families who do not receive health insurance through their employer. A benefit to the members, Cigna sponsors health and wellness programs to encourage a healthy living and to help lower health care costs. Programs include healthy programs for mothers and babies, chronic condition management, and also a 24 hour nurse help line. The 24 hour nurse line is able to help lower health care costs by allowing people to find answers on health questions from a nurse rather than having to visit an Urgent care or even local emergency room. Cigna offers many different plans for you to chose from...
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...Comprehensive Primary Care Initiative Vanessa Clark HCA/210 Sunday, November 18, 2012 Dr. Dawn Tesner The Comprehensive Primary Care Initiative is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care. Medicare will work with commercial and State health insurance plans and offer bonus payments to primary care doctors who better coordinate care for their patients. Primary care practices that choose to participate in this initiative will be given resources to better coordinate primary care for their Medicare patients. The Comprehensive Primary Care Initiative (CPC or CPCI) will benefit patients as well the health care field. The CPCI will increase payments from Medicare and about 45 private insurers to primary care physicians and practices that: provide higher quality, easily accessible care; engage patients and caregivers as they transform their practices; emphasize prevention and management of chronic and complex conditions; assure better communication across practitioners and effective use of health information technology; and ensure smooth transitions of care for their patients across settings such as hospitals to home. This initiative will promote patient engagement and use the feedback from patients and family caregivers to help assess how effectively primary care practices are transforming themselves. This will give patients and caregivers a voice and encourage real partnership between patients...
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...three types of health insurance in the U.S. The three main types of insurance in the United States include the Individual Health Insurance, Group Insurance and State Sponsored Insurance. The Individual Health Insurance policies allow the policy holder to hold health coverage on themselves, their spouse and dependants. It is usually more expensive that other insurances offered however. This type of insurance is tax deductable. With this type of insurance you are able to choose the coverage needed for your lifestyle. As long as the policy holder pays the premiums due they do not run the risk of prices going up as in group health insurance where the employer has the ability to pick and choose what coverage’s they are willing to use on their plans offered to the employees. The Group Insurance is offered to employees at a rate the employer chose. The insured can choose coverage for themselves or for family coverage. The benefits can include a lesser cost insurance since the employer pays a portion of the costs, better coverage in health care needs and the insured and their family members will not be excluded due to preexisting conditions. The last of the three is the State Sponsored Insurance which includes Medicare and Medicaid coverage for low income families and senior citizens. This coverage is usually a free insurance or low cost that covers 100% of health care needs and medications. Describe the three methods for categorizing of health insurance in the U.S. Indemnity...
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...program, which only paid benefits to the primary worker of the family at the age of 65 (SSA. 2015). The Social Security Administration was originally named the Social Security Board and changed its name in 1946 to Social Security Administration which it is still presently called. When the program initially started lump sum payments were paid out to the retirees and monthly payments did not start until 1940. Ernest Ackerman is claimed to be the first recipient of the lump sum in which he paid 5 cents into the Social Security program, and he ended up receiving a 17 cent lump sum payment upon retirement. In January month Social Security benefits were now approved not only for the primary worker, but also wives, widows, and children under 18.1940 Ida May Fuller was the first recipient to receive the first monthly retirement check, and collected benefits for 35 years dying at the age of 100 years old (SSA. 2015). Structure The current Social Security Administration has a structure that is broken up into regional offices, and multiple processing centers, to include numerous field offices. There is roughly 60,000 Social Security Administration employees in the organization that is headed by the Commissioner Nancy A. Berryhill. With 10 regional offices, in: Boston, New York, Philadelphia, Atlanta, Chicago, Dallas, Kansas City, Denver, San Francisco, and Seattle. With so many individuals in our society the Social Security Administration that are eligible for benefits they have 6 processing...
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...securities to raise cash Use of Economic transactions by FIs • Provide a center where savers meet borrowers • Provide economies of scale • Issue financial claims that are more attractive to the household savers than the claims directly issued by corporations, asset transformation o FIs purchase primary securities issued by finance corporations, they finance these purchases by selling secondary securities to household investors and other sectors in the form of deposits and insurance • FIs monitor the corporations keeping agency costs to a minimum • Liquidity risk: FI securities have better liquidity than corporate securities Functions of FIs • Provide a brokerage function along with asset transformation function o Asset transformation: issuing deposits to buy primary securities • Provide transaction services and information specialists • Enact monetary policy Primary Vs secondary securities • Primary o Financial claims issued by commercial corporations are invested in real assets • Secondary- FIs buy primary securities with money from savers o Savers indirectly buy the primary securities o The information and evaluation (ex-ante), monitoring, liquidity costs and price risk are reduced through the FI FIs as delegated monitors • Depositors delegate an...
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...3. Why might an individual prefer to belong to an HMO rather than a PPO, or to a PPO rather than an HMO? What are some primary differences between the two? Health Maintenance Organizations (HMO) are state licensed health plans that are regulated by HMO laws that require them to include preventive care, such as routine physical examinations and other services, as part of their benefits package. The goal of the HMO health insurance plan is to reduce the cost of healthcare. HMO plans typically have the lowest monthly premiums among other health insurance plans which lower patient monetary responsibility. Patents are required to pick a primary care physician. The insurance plan will not pay for services that are not in their provider network....
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...assignment of benefits patient's written authorization giving the insurance company the right to pay the physician directly for billed charges birthday rule used by insurance claims administrators to determine which parents plan will pay for the medical bills of a dependent child when the child is covered by plans of both parents capitation rate predetermined amount paid to provider every month regardless of the number of times the patient is seen within the month claim written and documented request for reimbursement of an eligible expense under an insurance plan. Clean Claim health insurance claim form that has been completed correctly without any errors or omissions Clearinghouse independent entity that reviews claims, requests clarification from the provider, and "cleans" claims, ensuring accurate information is documented, then submits claims to insurance companies in proper format CMS-1500 most common health insurance claim form used to file claims for physicians services Co-Insurance cost of claims shared by insurance company and insured after deductible Coordination of Benefits procedures to prevent duplication of payment by more than 1 insurance carrier Co-Payment predetermined amounts of money the patient must pay for medical services at every visit, as determined by the insurance company. Crossover Claim patient claIM THAT IS ELIGIBLE FOR BOTH MEDICARE AND MEDICAID; ALSO KNOWN AS MEDI/MEDI Deductible...
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...1. What is the primary function of an insurance company? How does this function compare with the primary function a depository institution? • The primary function of an insurance company is to provide protection from adverse events. Insurance companies accept the premium payments in exchange for compensation in the event that a certain specified, but undesirable, events occur. • The primary function of depository institutions is to provide financial intermediation for individual and corporate savers. By accepting deposits and making loans, depository institutions allow savers with predominantly small, short-term financial assets to benefit from investments in larger, longer-term assets. These long0term assets typically yield a higher rate of return than short-term assets. 2. What is the adverse selection problem? How does adverse selection affect the profitable management of an insurance company? • The adverse selection problem occurs because customers who are most in need of insurance are most likely to acquire insurance. However, the premium structure for various types of insurance typically is based on an average population proportionately representing all categories of risk. Thus, the existence of a proportionately larger share of high-risk customers may cause the premium revenue received by the insurance provider to underestimate the revenue needed to cover the insured liabilities and to provide a reasonable profit for the insurance company. 3. What are the similarities...
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