A Brief Note On The Health Care Industry

A Brief Note On The Health Care Industry
Phase 3 Individual Project
Hope Foster
HCM307–1501A–01: The Health Care Industry
Professor Glenda Byers Shaffer
January 26, 2015
Managed Care Organization Today we have been asked by Mr. Woods to provide training to
members of the public relations committee in order to help them understand care key terms so that
they can include them in their campaign for community education. Managed care organizations have
seen an enormous increase in enrollment since their initial rollout in 1988. Today, managed care
organizations have a 95% enrollment since their beginning. What I propose to do is list the key
terms with explanations so that the new members will be able to understand managed care and all of
its terminology. I am going to explain managed care and the different contracts that are attached to a
managed care organization.
Managed Care – This is a type of health care where patients sign up in a plan to visit particular
doctors and hospitals whereby the cost of care and treatment is monitored by a managed care
organization. (Free Dictionary, 2012). "A health care system with administrative control over
primary health care services in a medical group practice." (Free Dictionary, 2012).
PPOs – (Preferred Provider Organization) – This type of health care system has a list of preferred
providers that they want you to use and to get your health care from. You have to have pre–
authorization for tests and procedures. (Davis/Health Insurance, 2015).
POS – Point–of–Service
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Managed Care Programs Defined By Merriam Webster.com Essay
Managed Care Programs Defined Managed care as defined by Merriam–Webster.com is "a system
of providing health care (as by an HMO or a PPO) that is designed to control costs through managed
programs in which the physician accepts constraints on the amount charged for medical care and the
patient is limited in the choice of a physician." While the definition is appropriate for health plans,
physicians and government entities focused on cost control and utilization reduction; it does not
include the patient's expectation of increasing quality of care. Managed care programs remove the
majority of the consumer–driven or free market provider selection and health care choices by
establishing networks with preapproved providers. These programs include health management
organizations (HMOs), preferred provider organizations (PPOs), point–of–service (POS) options
and provider– sponsored organizations (PSOS), of which are all network based (Gage, 1998).
Patients who utilize a managed care program find there is little or no cost for receiving care within
the network, however, require referrals to see a specialist, high cost if a physician is outside of the
network, requirements of second opinions for costly procedures/ diagnosis, and pre–defined hospital
stay limits. On the other hand, physicians supporting managed care programs contract and accept
various risks, including insurability, utilization rate, price, reimbursement rates and legal risk
(Brown & Reiss, 2000) for the

Preferred Provider Organization Case Study
There are currently have two main insurance options available for consumers, Health Maintenance
Organization (HMO) and Preferred Provider Organization (PPO). Both health insurance plans are
great, but we will be focusing on the plan with lower costs in general which is Health Maintenance
Insurance, or HMO. HMO is an organized system of health care that offers medical services to its
members on a prepaid foundation. It combines health insurance and delivery functions in an effort to
keep low costs and maximize the quality care provided. There are several types of HMOs that are
available: staff model, group model, network model and individual practice association, or IPA. For
the staff model, physicians are salaried and have offices in HMO

Essay about Employee Benefits and Planning
Employee Benefits and Planning
What is the term PPO stands for? Preferred Provider Organization
What is the Characteristics of PPO? Tends to be used in two ways. One way to apply to health care
providers that contract with employers, insurance companies, union trust fund, third–party
administrators, or others to provide medical care services at a reduced fee. PPO may be organized
by the Providers themselves or by other organizations, such as insurance companies the Blues. Like
HMO they may take the form of group practices or separate individual practices, they provide a
broad array of medical services such as Physician¡¦s services, hospital care, laboratory costs¡K or
they may be limited to hospitalization or physician¡¦s services. ... Show more content on
Helpwriting.net ...
Participation can be limited to individual or include dependents and the account can be used to pay
unreimbursed medical expenses. It must be funded and a qualified trustee or custodian under the
same rules as MSA holds the funds
Know eligibility rules? (HSA) can be established by employees and self–employed and anyone else
who meet the following rules for qualification:
„X The individual must be covered by a high deductible health plan.
„X The individual must not be covered by another health insurance plan
„X The individual is not eligible to be claimed as a dependent on another person¡¦s federal income
tax return.
„X The individual is not entitled to Medicare benefits because of attaining age 65 or disability
„X The purpose of (HSA): in the case of individual coverage, the deductible must be at least $1000
and annual out of pocket cannot exceed $5000
„X In the case of family coverage, the deductible must be at least $2000, and annual out of pocket
can not exceed $ 10,000
Know contributions limits? Contributions to (HAS) for a self–employed or unemployed are made
directly by that person. The employer, the employee or both can make contributions. Family
members can also make contributions on behalf of other family members. No contributions can be
made if a person is eligible for Medicare. The maximum annual to an HS in 2004 is $2600 for an
individual and $5,150 for families.

Ftc Settlement Order Bars Texas Doctors ' Group From Joint...
FTC REVIEW AND DISCUSSION:
FTC Settlement Order Bars Texas Doctors ' Group from Joint Price Negotiations
Review:
The following allegation is upon Southwest health alliance who runs under BSA provider network in
the region of Amarillo, Tyler, TX who is believed to be respondent under section 5 of Federal Trade
Commission Act where the Respondent has exhibited Anticompetitive Conduct in the market and
which incurred the reduction of consumer benefits in the healthcare market. Upon being proved
guilty of allegations, Federal Trade Commission along with the help of Office of Texas Attorney
General purposed few judgements in the form of consent order which involves settlements purposes.
In detailed overview of this allegation, Federal Trade ... Show more content on Helpwriting.net ...
For all this contracting procedure, physicians can opt to choose a messenger which is known as
''messenger model'' under this the messenger can accept the contract terms from the payers and
should inform the physicians and collect the decision unilaterally whether physicians agreed to the
terms or not. Similarly, with the consent of physician group messenger can offer the proposed
contract by the physicians to payers.
In this instance, BSA Provider Network as a messenger under the contracting terms of '' messenger
model'' was implemented has made a conspiracy plot of making its own decisions by making its
own fee schedule instead the decision should be coming from the physicians association in receiving
and offering contracts to the payers. Although, BSA provider network has fixed charges many
physicians would provide healthcare procedures under their own fee–for–schedule to independent
patients, self–insured employers coming out of the terms of BSAPN. Also, BSA provider network
many renegotiations with several payers on behalf of physicians intending that the independent
physician

Preferred Provider Organizations (PPO) Plan
A preferred provider organization (PPO) plan gives patients the flexibility to see providers and
specialists within or outside the network of care; it will typically cost less to receive care from an
in–network provider (U.S. Centers for Medicare & Medicaid Services, n.d.). In most cases, referrals
for specialists and designating one physician as a primary care provider is not required of a PPO
plan. (U.S. Centers for Medicare & Medicaid Services, n.d.). Alternatively, a health maintenance
organization (HMO) limits patients to receive care from doctors, specialists, and hospitals covered
under the health plan (U.S. Centers for Medicare & Medicaid Services, n.d.). With the exception of
emergency can and out–of–area urgent care, all care providers

Essay On Healthcare Insurance
With the healthcare charges skyrocketing, people often find themselves in a financial crunch when it
comes to paying their medical bills. This is where a health coverage plan comes to their rescue. With
different types of plans available, one can choose the most suitable one and save themselves from
getting squeezed under huge medical bills.
Mandatory in many states, these helps people to pay their medical bills, hospitalization charges and
other payments for healthcare. A wide array of these plans are available in the market – both cheap
and expensive. With this many options, it becomes difficult for people to learn of all the plans and
choose the most suitable one.
Some plans are explained below.
Group Insurance Plan
To ensure better productivity, ... Show more content on Helpwriting.net ...
Individuals enrolling for this plan need to select a chief physician from the health care network. In
case individuals choose to opt for a doctor outside the network, then they have to pay a higher price
with a limited compensation from the company.
* Fee For Service Plans (FFS): This plan allows insurance holders to take health care decisions
independently. The holders pay for the service and then submit detailed insurance claims with the
health coverage company. If the services availed by the holders are covered under this plan, the
insurance agency reimburses the amounts.
Family Insurance Plan
This insurance plan covers individuals along with their family and help them meet any sort of
sudden heath problems. Family Insurance Plan is suitable for professionals, students, freshers and
unemployed. This plan is available to individuals of all ages up to a maximum limit of sixty years of
age. There are several benefits of this type of insurance;
* This plan is less expensive compared to group plans.
* With this insurance, the entire family is safeguarded from a sudden health

Healthcare Organization
Healthcare Organization 's – HMO vs. PPO Angela MacLeod, Ifeoma Jonathan HCS–413 April 17,
2011 Jeffery Dodd Healthcare Organization 's – HMO vs PPO Introduction A health care system is
the organization of people, institutions, and resources to deliver health care services to meet the
health needs of target populations. There are two widely known and used healthcare organizations
that deliver insurance to the vast majority of the population, Health Maintenance Organizations
(HMO) and Preferred Provider Organizations (PPO). This document will further compare these
organizations in how they communicate, management style, motivation, culture, conflict resolution
and ongoing management development. Communication ... Show more content on Helpwriting.net
...
PPOs allow consumers to seek care outside the network coverage but this allowance attracts extra
fee. PPOs provide prescription services at a reduced cost; have a larger network covering larger
geophysical areas. PPOs management style has advantages over HMOs as they less restrictive and
affords the consumers opportunity to use out of network facilities with prior approval at a cost.
PPOs are located in more geographical areas and makes access easier. Subscribers are not stuck with
a PCP nor require referrals to see providers outside the network. Consumers file for claims for
reimbursement when visit is made to out of network health provider Motivational Methods There
are as many different methods of motivating employees today as there are companies operating in
the global business environment. Still, some strategies are prevalent across all organizations striving
to improve employee motivation. The best employee motivation efforts will focus on what the
employees deem to be important. It may be that employees within the same department of the same
organization will have different motivators. Many organizations today find that flexibility in job
design and reward systems has resulted in employees ' increased longevity with the company,
improved productivity, and better morale. Conflict Resolution With the need for constant change
comes conflict. There are several strategies for handling conflict, avoidance,

Health Maintenance Organization: Managed Healthcare System
A Health maintenance organization (HMO) is a type of managed healthcare system. HOM's and
their close cousins, preferred provider organization PPO's, share the goal of reducing healthcare cost
by focusing on preventative care and implementing utilization management controls. HMO plans
offer a wide range of healthcare services through a network of providers who agree to supply
services to members.
Preferred Provider Organizations (PPOs) consist of a network of hospitals, healthcare facilities,
physicians and labs that patient may choose from for services and the services will be covered under
the insurance policy. Managed care organizations (MCOs) began to proliferate during the 1980s. A
Managed Care Organization (MCO) is part of a Family

Preferred Provider Organization Essay
Greater than 150 million workforces, pensioners and their household members receive their
healthcare through occupation–based coverage, which, in accordance with the AFL–CIO, is the
foundation of this nation state health care coverage and financing. Approximately one–third of
occupation–based coverage comes through coalition–negotiated strategies. (The AFL–CIO, n.d.)
However, through collective bargaining, coalition associates and their families have managed
considerably sounder than non–alliance working individuals, counterattacking much, although not
all, of the cost–shifting necessitated by proprietors. However, the result has been decrease salary
increases and the loss of respectable appointments, as proprietors converted to lower cost ... Show
more content on Helpwriting.net ...
A Preferred Provider Organization plan is one which permits liberate movement equally within and
outside of the organization's contributing provider association. The association may incorporate
general physicians, experts, laboratories, diagnostic services, outpatient or free–standing
accommodations, hospitals, resilient medical equipment, apothecaries, opticians, holistic/alternative
contributors, therapists and more. "Free movement" inside the arrangement is generally referred to
as referral–free access (or self–referral) to practitioners, specialists and more. Supplementary
arrangement models will necessitate the preference of a Primary Care Physician (PCP) who is
subsequently responsible for evaluating your care requirements and composing the applicable
referrals for additional maintenance. Though, in a referral–free PPO plan various hospital
admissions, diagnostic assessment, out–patient surgical treatment and more will necessitate pre–
authorization. This is a procedure of informing the insurance provider of your intents to have
specific services provided and basically obtaining their consent to do so. (Conference Associates,

Managed Care Essay
Managed care dominates health care in the United States. It is any health care delivery system that
combines the functions of health insurance and the actual delivery of care, where costs and
utilization of services are controlled by methods such as gatekeeping, case management, and
utilization review. Different types of managed care plans came into development by three major
factors. These factors include choice of providers, different ways of arranging the delivery of
services, and payment and risk sharing. Types of managed care organizations include Health
Maintenance Organizations (HMOs) which consist of five common models that differ according to
how the HMO is related to the participating physicians, Preferred Provider Organizations ... Show
Case managers also provide support and information to patients and their families. Next, is
utilization review. `Its main objective is to review each case and determine the most appropriate
level of services, the most appropriate settings in which the services be delivered, the most cost
efficient methods for care delivery and the need for planning of subsequent care. Other methods
used for utilization and control are choice restriction and practice profiling' (Douglas, 2003, p.328).
The types of managed care are differentiated by definition, operation, structure, and information
needs. `HMOs were the most common type of MCO until commercial insurance companies
developed PPOs to compete with HMOs' (Douglas, 2003, p.331). `HMOs are business entities that
either arrange for or provide health services to an enrolled population after prepayment of a fixed
sum of money, called a premium' (Peden, 1998, p.78). There are three characteristics that an HMO
must have. The first is a health care financing and delivery system that provides services for
members in a particular geographic area. Second, is ensured access to a complete range of health
care services, health maintenance, treatment, and routine checkups. Last, health care must be
obtained from voluntary personnel that participate in the HMO. The five HMO models related to the
participating physicians are the Staff

Case Study: HMO Standss For Health Maintenance Organization
HMO stands for health maintenance organization , with this health plan you can select your primary
care physician who will be responsible for your basic healthcare needs. If you need a referral to see
a specialist your PCP has to send a referral over. Note the referral of the specialist must be within
the HMO network. If you would like to see a doctor that is considered outside of the network or
without a referral, you will brunt the cost, you will be responsible for all out of pocket cost, unless it
a medical emergency and you have no other choice.
PPO stands for preferred provider organization. With this health plan can go to any primary care
physician (PCP) and you do not have to have a referral in order to see a specialist. If you

Essay about Managed Care
Managed Care
There are so many problems with our society's health care. Everyone wants to find a
solution, but no one has been able to come up with one yet. Many different things have been
tried, but none have put a cease to the exorbitant costs, which most believe to be the main
problem. Out of everything tried, the most recent and popular system is known as managed care.
Managed care is the most common form of health insurance in the United States, and provides
more a cost efficient coverage than paying a fee–for–service charge. However, it is also a very
complicated system. Over the next few pages I am going to try and go over the main parts of the
managed care structure. In the end, I am going to ... Show more content on Helpwriting.net ...
Although the goals have not yet been met, managed care has
continued to grow throughout the past four decades. At the end of 1996, there were over 600
HMO's in operation, enrolling around 65 million members, which is about 1/4 of the population
(Tufts 1998).
Before I get into the different types of managed care organizations, I am going to go over
some cost control methods in managed care. Managed care organizations are different methods
used to control utilization of services. Utilization management requires three things. First, you
have to have an expert evaluation of which services are medically necessary in a given case. This
ensures that unnecessary services are kept to a minimum. Secondly it requires a determination of

how those services can be provided most inexpensively, while maintaining a high level of
quality of care. It also requires a review of the process of care and changes in the patients
condition to revise the course of medical treatment if necessary. The methods that are most
commonly used for utilization monitoring and control are choice restriction, gatekeeping, case
management, utilization reviews, and practice profiling.
The first method I am going to talk about is choice restriction. Traditional health
insurance gave the insured open access to any provider. This led to an over use of services. Most
of the managed care plans have some sort of

Health Insurance Matrix Essay
University of Phoenix Material
Health Insurance Matrix
Origin: When was the model first used?
What kind of payment system is used, such as prospective, retrospective, or concurrent?
Who pays for care?
What is the access structure, such as gatekeeper, open–access, and so forth?
How does the model affect patients? Include pros and cons.
How does the model affect providers? Include pros and cons.
Indemnity
In 1932 the American Medical Association (AMA) adopted a strong position against prepaid group
practices, favoring instead indemnity–type insurance that protects the policyholder from expenses
by reimbursement (Jones & Bartlett, 2007). As one of the first health policies in the U.S., indemnity
plans are considered ... Show more content on Helpwriting.net ...
Potential for higher payment amounts at time of service. Alternatively, there is a potential for greater
debt amounts. Larger debts will make it necessary for health care providers to be more aggressive
for collections. Providers will also encounter increased staff costs in order to follow–up with
patients in advance of treatment, as well as in subsequent collection efforts (Fifth Third Bank,
2008).
Point–of–service
HealthPartners of Minneapolis pioneered point–of–service (POS) plans in 1961, but the concept
took 25 years to get off the starting blocks (Dimmit, B., 1996). In 1986 CIGNA Healthcare launched
Flexcare, the first POS plan. By 1995 forty percent of employers with at least 200 employees
offered POS plans.
Providers within a point–of–service network are usually paid a capitated fee. The fee is fixed and
does not alter regardless of services rendered. POS plans operate using a prospective payment
system. Insurance companies reimburse providers an agreed amount that is decided before a patient
receives services.
Patients are responsible for paying a co–payment when visiting a doctor. After the patient is seen,
the provider submits claim forms to the insurer for the services rendered. Once the claims are
processed the insurer will reimburse the provider (Austin & Wetle, 2012). If a patient goes out–of–
network, they are required to pay the provider in full. Afterwards the patient can submit a claim for
reimbursement.

Point–of–service insurance plans

Advantages And Disadvantages Of Managed Care Organizations
Manage Care Organizations
The United States has a unique system of healthcare delivery, it is complex and massive. Twenty–
five years ago; American citizens had guaranteed insurance, meaning the patient could see any
physician and the insurance companies and patients would share the cost. But today, 187.4 million
Americans have private health insurance coverage (Medicaid, 2014). The subsystems of American
health care delivery are Managed care, military, vulnerable populations and integrated delivery
So what is Managed care?
Managed care is a system of healthcare delivery that seeks to achieve efficiency by interpreting the
basic functions of healthcare delivery. It employs mechanisms to control (manage) utilization of
medical services and determines the price at which the services are purchased and how much the
providers get paid.
Managed care is the most dominant healthcare delivery system in the United States and available to
most Americans. Employers and government are the primary financiers of managed care. The
managed care sector includes approximately
540 licensed Health Maintenance Organisations (HMOs)
925 Preferred Provider Organisations (PPOs)
Advantages of Managed Care:
Private care management organizations in close connection with providers obtain claims for services
rendered
Providers have a more predictable and stable cash flow
Education of members on plan benefits and how to access appropriate level of care for these patients
Promote better outcomes for the patients by providing health education prevention program
Disadvantages of Managed care:
Rigidity of rules, related to the choice of healthcare providers
Pay out of pocket, when consulted with another provider for extended care, as the provider not
included in the network
Unnecessary treatments and tests performed on patients in order to make money (or) tests and
treatments not performed due to lack of money
The prime types of Managed care organizations (MCOs) are:
Health Maintenance Organisations (HMOs)
Preferred Provider Organisations (PPOs)
Point of Service (POS)
A health plan is a contractual arrangement between the MCO and the members; it includes a list of
covered health services to which members are entitled
Health Maintenance

Health Care Plan For Healthcare Care
Managed care plans are the most common form of health care coverage offered in the United States
today. One of the reasons that managed care plans have become so popular is because employers are
the ones footing the bills for most medical coverage. Managed Care plans work off the basic
premise that health care costs can be better controlled by controlling access to health treatments and
services. The three main categories of managed care plans is HMO, PPO, and IPA. Health
Maintance Organization
Health Maintance Organization (HMO) is a type of managed care organization system, according to
it provides a wide range of health insurance services through a network of hospitals, physicians, and
other health care providers having a ... Show more content on Helpwriting.net ...
In this case they should be ready to deal with referrals and pay more a substantial deductible, co–
payment, or coinsurance for the use non –panel providers. According to Mark & Mueller, (1996)
"HMO members will pay premiums which is through an employer, which will be deducted from
their paycheck, some employers may pay the premium costs for you". Copayments in the other hand
are received to cover medical services like emergency expenses or specialized care. Deductibles is
the amount you pay out of pocket before the HMO starts while maximum out of pocket expenses is
the maximum amount you have to pay for covered services during a certain period of time. HMO
pays benefits only if you use physicians and hospitals within the plan's network. HMO members
normally do not have to file claims and wait for reimbursements.
Preferred Providers Organization
The preferred provider organization (PPO) is a combination of traditional fee–for–service and an
HMO. Like an HMO, there are a limited number of doctors and hospitals to choose from, according
to Muino, (1992) "a preferred provider organization (PPO) is a health plan that has contracts with a
network of preferred providers from which you can choose". In a PPO plan you do not need to select
a PCP and you do not need a referral to see other providers in the network. If you receive care from
a doctor in the preferred network you will be responsible for

As you learn about health care delivery in the United States, it is important to understand the various
models of health insurance to develop a working knowledge as you progress through the course. 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 as important
foundational information for your role as a future health care worker. Fill in the following matrix.
Each box must contain responses between 50 and 100 words using complete sentences.
Include APA citations for the content you provide.
What kind of ... Show more content on Helpwriting.net ...
Indemnity health plans run on a retrospective payment system. A member has a monthly premium.
Co–pays and a deductible. Upon visits the provider submits claims for services rendered to the
insurance company, upon which the insurance company pays their part and the member is billed for
the remaining balance to be paid out–of–pocket.
With indemnity plans employers deduct the monthly premium from payroll of each employee on the
plan. Both the member and the insurance company pay for services rendered. Upon receipt of the
services the insurer pays the provider their portion if the deductible has been met. The member is
then responsible for the remaining balance and the co–pay at the time of service.
The structure of an indemnity plan is completely "open access". The member may choose any
provider or specialist they would like. In an indemnity plan there are no restrictions on providers or
provider type. It is the member's responsibility to seek and sign on with their preferred provider or
specialist.
Positive aspects of indemnity plans include the liberty of the member to choose their preferred
provider or specialist and their preference of type of care they wish to receive. A negative aspect of
indemnity plans from a members stand point is the cost of these plans. Premiums and deductibles
then to be higher with indemnity plans over other insurance plans due to the freedom

Preferred Provider Organization Case Study
How Can A Preferred Provider Organization Help Someone Who Is Battling A Drug Addiction? It
can be difficult for someone who is battling an addiction to know where to turn to for help. Many
people feel as though they are alone in battling their ordeal. It can also be difficult for a person to
admit to him or herself that there is a problem. How do people get help once they admit that they
need it? The money invested in rehab is definitely worth the cost. However, many people have
trouble affording it. Fortunately, a preferred provider organization, or PPO, can help people pay for
their drug treatment. How Can A PPO help me get into rehab? Your insurance plan can help you get
rehab if you are a part of a preferred provider organization.

Identify Three Types Of Employer Organizations As...
Anne Grandy
Identify three types of managed care plans, such as Preferred Provider Organizations (PPO) and how
they impact the way that health care is delivered at Healing Hands Hospital.
Managed care is the provision of health care services being taken on by a single organization in the
management of finances, insurance, delivery and payment (Shi, Singh, 2017). Additionally,
managed care plans are a type of health insurance that contracts with health care providers and
medical organizations, whereas the members are provided care at a reduced cost, usually the lowest
possible cost. The amount paid depends on the rules of a specific network.
The three types of managed care plans include, Health Maintenance Organization (HMO), Preferred
Provider Organizations (PPO), and Point of Service (POS). With the HMO plan, a primary care
doctor is chosen, and coverage is for care provided within the network. The PPO plan pays more if
care service stays within the network, than it pays if care is done outside of the network.
Furthermore, the POS plan allows the patient to choose between the HMO and the PPO, for each
visit to the doctor (healthychildren.org).
Managed care has changed dramatically in the United States over the years. What did managed care
look like 10 years ago compared to how it looks today? managed care grew more in the last years,
bringing about new types of managed care plans through competing MCOs. To make their plans
more attractive, organizations used payment variations. For instance, instead of capitation, PPOs
used discounted fees payment. There were ones that offered enrollees choices between affiliated
providers and non–affiliated providers. MCOs also adopted various methods to control health care
costs by actively monitoring utilization (Shi, Singh, 2017). Additionally, private health insurance, as
well as high deductible health plans, can be offered as managed care plans nowadays. Also,
available to Medicare and Medicaid recipients is the option to enroll in a managed care plan or
continuing to stay with the traditional fee–for service program. Now for specific services HMOs
incorporates capitation and fee–for–service reimbursement, in their payment schemes.
Discuss the future of managed care

Preferred Provider Organization (HMO)
Health Maintenance Organization (HMO)
An HMO delivers all health services through a network of healthcare providers and facilities. A
primary care doctor to manage the care and refer to specialists when we need one so the care is
covered by the health plan; most HMOs will require a referral before we can see a specialist. The
plan may require us to pay the amount of a deductible before it covers care beyond our essential
benefits. There are no claim forms to fill out.
Preferred Provider Organization (PPO)
We do not have to get a referral from a primary care doctor to see a specialist. Higher out of pocket
costs if we see out of network doctors vs. in network providers. More paperwork than with other
plans if we see out of network providers.

Hmo ( Health Management Organization ) Is A Preferred...
Chasity Garrison
9/12/2014
Insurance Project
MA 215
HMO (Health Management Organization) is a preferred provider organization. Their focus is to
reduce the cost of the preventative care as well as implementing utilization management controls as
part of their goal. Being part of a HMO, you can choose the primary physician for medical purposes.
One of the advantages are the low cost out of pocket costs for the patient's insurance. Each time you
seek medical care you are only obligated to pay a percentage of the bill. Members of HMO are at a
fixed cost for the monthly fees. HMO tries to encourage the patients to stay on top of their health,
and not let their illnesses get to out of hand by letting it get worse. Another advantage, is that being
part of the HMO, your offered education classes and discounted club memberships for your health.
The disadvantages of the HMO consist of some strict controls. An example of an advantage would
be if you decided you wanted to receive care from another doctor or specialist, it must be consulted.
Although by doing the consultation, which helps lower the cost for the HMO and the member, it can
also cause problems if your physician doesn't provide you with the referral. When you receive care
from a provider that's not part of a HMO, the organization will not pay for services that are non–
emergency from the physician. (Medical Billing, n.d.) PPO (Preferred Provider Organization) is
considered the group of physicians and hospitals that

Quiz 2 Wk 6 Essay
Question 1
1.
Companies can choose from which four classes of health insurance programs?
Fee–for–service, managed care, point–of–service, consumer–driven health care
Indemnity, health savings accounts, managed care, fee–for–service
Point–of–service, fee–for–service, indemnity, managed care
Self–funded, managed care, fee–for–service, point–of–service
0.2 points
Question 2
1.
Companies must offer HMOs if they are subject to the minimum wage provisions of FSLA.
True
False
0.2 points
Question 3
1.
What are the three common forms of managed care plans?
Individual practice organizations, point–of–service plans, health maintenance organizations
Health maintenance organizations, preferred provider organizations, ... Show more content on
Helpwriting.net ...
Employees, of covered employers, qualify for FMLA leave when they meet the following
qualifications.
Worked 1025 hours in a 12 month time span

0.2 points
Question 18
1.
Under FMLA, if an employer requires a second medical opinion on a request for leave, the
employer must pay the expense.
True
False
0.2 points
Question 19
1.
This Act gives individuals the right to employment by the company they worked for prior to military
service.
Fair Labor Standards Act
Uniformed Services Employment and Reemployment Rights Act
Military Reemployment Act
Military Services Reemployment Act
0.2 points
Question 20
1.
Wellness benefits can be offered as part of employee assistance programs or as separate benefits.
True
False
0.2 points
Question 21
1.
How much can companies save by investing in preventative health care programs?
For every $1 invested, they can expect to save as much as $16 in medical insurance costs
For every $1 invested, they can expect to save as much as $6 in medical insurance costs p. 256
0.2 points
Question 22
1.
These three objectives were cited as contributing the most to reducing

Preferred Provider Organization
Health insurance has been a matter of concern for long in the U.S. Several laws have been
formulated to ensure every individual get insurance cover. The latest law is the Affordable Care Act.
Every insurance company has its own products offered. There are various types of insurance offered.
The most common types of health insurance plans are health maintenance organization (HMO),
Exclusive Provider Organization (EPO), Preferred Provider Organization and Point of Service
(POS) Plans.
Every type has different levels of coverage of care as per the company policies. Health maintenance
Organization offers a wide range of coverage. Its premiums are low. It requires one to choose a
primary care physician who will be the one responsible for most of the healthcare needs. Exclusive
Provider Organization plan on the other hand, is a managed care system where one is allowed to get
health care only from doctors and specialists within a network except during emergencies. Members
of EPO can negotiate for lower rates with the providers since they are restricted to doctors who are
in the network only. Preferred Provider Organization is a type of health plan which also has a
network of doctors, hospitals, and other specialists who have agreed to offer services at subsidized
rates. Services offered by doctors in the network have low cost than that outside network. Point of
Service plan combines the characteristics of HMO and PPO. Members of this plan are supposed to
choose a primary care

The Role Of Finances For Health Care Systems
The role of finances for health care systems Inc. will be for managing the business's finances. This
ensures having cash available for expenses to ensure the business stays afloat and to ensures there is
cash to provide a cushion for any costs that come up unexpectedly. Ensuring that the finances are
managed means the company can make plans to ensure the future of the company (Brumley, 2015)
and utilize the resources of the company to ensure its running at peak proficiency. The primary users
for the financial information will be the finance department which consists of the chief financial
officer, comptroller, treasurer and the personnel in charge of specific financial information within
the company departments. This whole department reports to the chief executive officer who is
responsible for all financial transactions for the company (Gapenski, 2013). There are many legal
and regulatory issues that this business has to follow due to being in the health care industry. Some
of these issues are that the health care industry is highly regulated for people entering the industry
for the well–being of the public. The personnel working in the health care industry have to be
licensed or state certified. The facilities themselves have to be licensed and inspected by state
personnel that ensure the quality of the facility and the personnel. The legal concerns for this health
care business are varied for the health care industry but the primary concern is professional

Health Insurance Plan For Quality Assurance
An Insurance Plan
Choices are a part of life. We make choices everyday, sometimes without giving much thought at all
regarding our selections. Nevertheless, some of our choices must be carefully weighed. One such
choice is our health insurance coverage. The selection of our health insurance plan has
considerations which are complex and carries with it consequences which can reach far into our
future (Bhargava, 2015).
Health Insurance Plan Requirement
In selecting a health insurance plan, certain elements of the plan were necessities. First, the plan
must include coverage for both myself and my husband. In addition, plan costs such as copays and
deductibles were important; however, they are not as significant a factor as the monthly premiums.
The desire to keep monthly payments low does not necessarily mean I will only have undesirable
policies are options. In fact, a study by the National Committee for Quality Assurance (NCQA) in
2013 revealed that an expensive policy does not automatically equate to better care (Find a "Best
Value" Health Plan, 2013). Finally, since I am a cancer survivor, the ability to continue to use my
current healthcare providers was of great importance.
Issues To Avoid in Selecting a Healthcare Plan In selecting a policy there are also issues relating to
selecting a policy which can be considered a mistake if not aware of the repercussions of these
issues. Avoiding making one of these mistakes is in the forefront of my decision making

Provider Reimbursement Essay
The concept of provider reimbursement is to make sure payments are being made for the services
rendered that are process by the insurance companies or by the third party to a beneficiary,
Reimbursement happens when an approved healthcare physician or facility offers medical care to an
insured party, this can help the patient because they won't have to pay up front for the services
instead a claim will be submitted to the patients insurance plan. The healthcare provider is going to
verify the insurance to make sure the patient is cover for the procedures that way the insurance
company can reimbursed directly, but in some cases if the patient insurance don't cover the
procedure the patient can make payment arrangements. The reason why reimbursement is necessary
is because the provider of facility must recoup all or some parts of the medical charges. The
different methods of financing for healthcare are for For Profit, Not–For–Profit and Public health.
For Profit is an organization that is made to make money and they are expected to bring more
revenue than needed. Not–For– Profit is an organization made to reinvest excess revenue into the
organization not like For Profit they have to reinvest the money back to the facility when For Profit
may pay out profits to investors, and the other financial method is public health care facilities this
organization is established by the government operated by a local, state, or federal government, they
are supported by tax dollars, and

Evolution Of Managed Care And The Forces That Have Driven...
Describe the evolution of managed care and the forces that have driven its evolution.
Managed care and its competition is being viewed to solve their issue on the struggle to control
rising health care costs. Managed care can be defined a system of delivering health services in
which care is delivered by a specified network of providers who agree to comply with the care
approaches established through a case management process. Managed care has a one hundred years
of history in the United States, and it gained national recognition around mid–1970s. The health
maintenance organizations (HMOs) are managed care organizations. There are two categories of
MCOs are, preferred provider organizations (PPOs) and point of service plans
(POS). There are over half of Americans with health insurance are enrolled in managed care plans.
Currently the debate in the United States is in regard to the quality of care provided by MCOs and
traditional fee–for–service plans. Another major issue with managed care is the use of gag clauses in
contracts amongst the MCOs and their providers. These clauses limit providers from being more
informative to patients about the alternative treatments or the details of reimbursements for
providers. The U.S. health care reform failed in 1994, and it caused a more focused turn to the
marketplace to provide the stimulus for reducing costs.
A few new trends are rising as managed care enters its second generation: dual– and triple–option
plans with

Managed Care Term Paper
U.S. Health Care Delivery System
Term Paper
Margarita Blanco
March.29th, 2010
Managed care was started as early as the 1900's, the cited pioneer of the structured system of care
that is known today as "Managed Care" is Dr. Michael Shadid. His goal was to help meet the health
care needs of a certain groups of people. Such as: rural residents, workers and families in the
lumber, mining and railroad industries; the enrollees paid a set fee to physicians who then delivered
care under the terms of their agreement. By 1929 the Los Angeles department of water and power
contracted with Drs Ronald Ross and H. Clifford Loos to provide service for almost 2,000 ... Show
If you choose to go outside of your network for health care you will get charge a deductible like a
PPO plan, charges will be about 300 dollars for and individual or 600 dollars for a family. For some
reason when I was researching managed care majority of the websites I came across never
mentioned Exclusive Provider Organization [EPO] then I finally came across it. Exclusive Provider
Organization [EPO] is the type of managed care that if you get healthcare outside of your network
you will have to pay for it out of pocket, so its not like a Point of Service where you'll get charged a
deductible or a percentage in this case your on your own. Being that EPO member are restricted to
in network doctors they are able to negotiate prices. EPO does charge co payments each visit that
ranges from 20–30$ and charge a monthly premiums and deductibles. I chose to save the best for
last; I will be talking briefly about Health Maintenance Organization [HMO] as well as its
advantages and disadvantages. I chose HMO because it was the first form of Managed Care. The
earliest from of HMOs can be seen in a number of prepaid health plans tracing back to 1910 the
western clinic in Tahoma, Washington offered lumber mills owners and their employees certain
medical services from is providers for a premium of 50 cents. However; the first HMO considered
in the United States was the Ross–Loss Medical Group in 1929 as I said earlier.

Independent Healht Insurance Company: BlueCross and...
Introduction
BlueCross BlueShield Association (BCBSA) is an independent health insurance association which is
founded in 1929. It is made up by 37 different health insurance organizations and companies in the
United States. They directly or indirectly provide health insurance to over 100 million Americans.
Under the Association, it has two famous products. One is Health Maintenance Organizations
(HMOs), and the other is Preferred Provider Organization (PPOs). Most American who has health
insurance from their employer are enrolled either an HMO or PPO. All of these managed care plans
go through the health plan's network, which contract with doctors, health care providers, clinics, and
hospital.
Body part
Health Maintenance Organizations (HMOs)
HMO is an organization that provides or arranges managed care for health insurance, individual and
other entities in the United States. It existed prior to the 1970s, which required employer who has 25
or more employee to offer HMO healthcare. In most of HMO plans, it required the insurers to select
a primary care physician (PCP) who is responsible for all their healthcare services. If they need care
from a physician specialist in the network, their primary care physician will have to provide them
with a referral. If they don't get the referral or they select to go to see a doctor outside of your
HMO's network, they will most likely have to pay all or most of the cost.
Preferred Provider Organizations (PPOs)
In health insurance, a

Preferred Provider Organization Research Paper
Preferred provider organization (PPO)
Perferred providers orginaztion asl known as PPO is an advanced–based medical care. The
membership allows a dicount below the regularly charge of rates to the asigned professionals
grouped together with the organizations. Ppo themselves earn more money by charging cilents for
the acess of the insurance company. PPO have plans that provide a lot of flexibility when choosing a
physician or hospital. The features also have a network that physicians; are some restrictions to
seeing a non–network physician. Your PPO will pay if you see a physician that isnt in the network.
It can be a smaller rate. Here are some bennefits that you can see a specialist first without having to
being seen to by your physician. You can go to any hospital outside your network and still be
covered for. You'll have more benefits if you stay in your plan. Premiums are usually higher, and
more common for there discount.
Health management organization
HMO has access you can use to certain doctors and hospitals that's in your network. The network
has physicians that agreed to lower rates to plan members that ... Show more content on
Helpwriting.net ...
Manage care are a contract with health care physicians and othe meidcal clinics that gives care to
member at a lower price. The network plan is made by these providers. The cost of the care plan
normally pays client son this network's rule. Plans sometimes make your choices cost you less. A
flexible plan is provided, it may cost you more. Theres three manage care plans: health maintence
organization formally know as HMO normally pays the care in your network. You must choose your
primary physician who will manages most of your care. Perferred provider orginaztion known as
PPO normally pays more if you saty within your network and they still pay half of the cost outside
the network. Point of serives POS plans give the oppurtunity to choose between HMO and PPO
everytime you in need for

health insurance matrix HCS/235 Essay
As you learn about health care delivery in the United States, it is important to understand the various
models of health insurance to develop a working knowledge as you progress through the course. 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 as important
foundational information for your role as a future health care worker. Fill in the following matrix.
Each box must contain responses between 50 and 100 words using complete sentences.
Include APA citations for the content you provide.
What ... Show more content on Helpwriting.net ...
According to Austin and Wetle (2012), employers covered 83% of premium costs for single
coverage and 73% for family coverage in 2009. The employee, or beneficiary, paid the difference.
Then, the health insurance company pays the provider directly.
Example:
HMOs have the strictest access structure, called a gatekeeper model, where patients must have a
primary care physician (PCP) through whom all care is routed. PCPs decide which diagnostic tests
are needed and control access to specialists through referrals, deciding when it is necessary for a
patient to seek more expensive specialty care (Barsukiewicz, Raffel, & Raffel, 2010).
Example:
HMOs are usually the least expensive health plans, offer predictable costs for health care, the least
administrative paperwork, and cover preventive care (Barsukiewicz, Raffel, & Raffel, 2010).
However, HMOs also restrict direct access to specialists by requiring referrals by a PCP, requiring
patients to see a provider in the HMO network, and often not covering more costly procedures or
care options, because care is managed to control excessive or unnecessary care. Providers gain if
they provide less care (Austin & Wetle, 2012). This incentive could affect patient–provider trust.
Example:
Advantages of HMOs are that a known amount of revenue is guaranteed and the patient population
number is fixed (Austin & Wetle, 2012). In addition, if providers use less in services than the
capitated fee,

Questions On Types Of Payment
1. Types of Payment
(1) Fee–for–Service (FFS)
Under FFS payment system, each service is unbundled and paid for separately. Fee–for–service
generates payments driven by the volume of services produced. The service providers, usually a
physician, receives a set fee for a particular service, such as office visit, test, procedure, or other
health care service, either directly from the patient or from an insurer or other payers.
(2) Health Maintenance Organization (HMO)
HMO represents an insurance plan in which individuals or their employers pay a fixed monthly fee
for services instead of a separate charge for each visit or service under the network healthcare
system. The monthly fees remain the same, regardless of types or levels of services provided. The
reimbursement amount is according to copay and deductible detail in the contract. With an HMO
plan, individuals or employers must select a Primary Care Physician (PCP) from a network of local
healthcare providers under the HMO plan. HMO beneficiaries must arrange and visit their PCP first
for the service or treatment. PCP will provide a referral to a trusted, in–network specialist or
hospital, if they cannot help. However, HMOs don't cover costs of care from an out–of–network
physician, hospital or facility except in the case of a true medical emergency.
(3) Preferred Provider Organization (PPO)
A Medicare PPO Plan is a type of Medicare Advantage Plan providing health insurance coverage to
customers offered by

Healthcare Paper
1a. What model of healthcare does the US and your chosen country have (Japan)? Be very specific.
The United States has a healthcare system that is different from almost every country in the world. I
would call the United States health care system a hybrid type system. I would call our system a
hybrid because we fall into almost every type of category possible when it comes to health care; for
instance, people who are uninsured have to pay out–of–pocket when they want to see a doctor
versus someone who is insured and only has to pay a deductable. Many companies in the United
States offer free medical care for employers, or they make health care insurance fairly cheap to
afford. Unlike many countries our healthcare system is a little ... Show more content on
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The person who utilizes this plan generally has to pay co–pay, which the cost varies depending on
the type of plan you have. Many people like this type of plan because when you go to the doctor you
don't need to fill out claim forms. Members show a card when they go to the doctor or hospital. The
downfall to this plan is that you might have to wait longer in the waiting room. Another plan the
United States has is called point–of–service plan. This plan allows the members of the plan to refer
themselves to an outside plan and still be able to obtain some coverage. A doctor can also make a
referral out of the network and in–turn the health care plan will pay for most if not the entire bill. A
preferred provider organization is another type of plan offered by the United States. Just like the
health maintenance organization, the preferred provider organization limits you to the number of
doctors you can see, but when you do find the right doctor most of your medical bills are covered.
The preferred provider organization requires you to choose a primary care physician in order to
monitor your health care. If you elect to go to a doctor who is not part of this plan, some of the
medical expenses are covered. I deem some people like this plan because if their primary care
doctor is not part of the plan, they don't have to change doctors. According to Health Insurance. Info
"An Exclusive Provider

The Silent Discount Dilemm Ppos
The Silent Discount Dilemma: PPOS In the world of health care finance, managers are faced with
many ethical decisions. This is often the case when it comes to the medical billing side of
healthcare. There are currently several billing schemes in practice that are under scrutiny by the
American Hospital Association (AHA) and the American Medical Association (AMA). One such
scheme is the practice of taking discounts on medical claims that your company is not entitled to.
This practice is referred to as a "silent PPO." To understand this practice better, it is important to
understand what a PPO is and how it works. The acronym PPO stands for Preferred Provider
Organization. A Preferred Provider Organization (PPO) is one type of ... Show more content on
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Instead, customers are encouraged to use providers within the network through offering them
reduced rates for service. When a customer uses a provider that participates with the program, they
pay less in the form of out of pocket copayments. These discounts are available because the health
care providers within the network have contracts with the PPO stating the agreed upon discounted
rates the providers will be paid when they provide services for members of that particular PPO
(Gapenski, 2013). A silent PPO is what you have when a legitimate PPO sells its provider network
information to other groups or to brokers (Jones, C., Mills, T., 20060. The hospitals and physician
groups who have contracted with that PPO to provide discounted rates usually do not know anything
about this outside arrangement. This practice allows payors to receive discounts that they are not
legally entitled to (Jones, C., Mills, T., 2006). Any time a payor receives the under–the–counter
discounts on medical claims that the provider is not legally obligated to give, it is referred to as a
silent PPO (Speisman, A., Hachenburg, M., 2006). It is perfectly legal for PPOs to make the
information regarding who their preferred providers are, as well as the discounts that the PPO has
contracted with these providers, available. According to current law, it is also legal for the PPO to
charge a fee for this information. Brokers can buy this information, and sell it to payors. The

Features of Private Payer and Consumer-Driven Health Plans
Features of Private Payer and Consumer–Driven Health Plans
The following reading is to familiarize the reader with private payer plans and types of consumer–
driven health plan (CDHP) accounts. Private payer plans such as PPOs, HMOs, and Group HMOs
are the most popular but there are also others to consider when making decisions on health
coverage, which are IPAs, POSs, and Indemnity plans. The CDHP accounts are made "for the
consumer" and therefore consumers (patients) have a say in what kind of plan they wish to have and
sometimes consumers can build their own health plan according to their financial situations with
savings account options. After reading this information, the reader will have a clearer idea of the
options available through ... Show more content on Helpwriting.net ...
The features of this type of plan are the same as a HMO except all members under this plan have no
choice but to visit their specific HMO providers and hospitals. The HMO pays the IPA for services,
and then based on pre–arranged capitated rates or fees; the IPA pays the providers under this plan
(Valerius, et al 2008).
Point–of–service (POS) plans involve both HMO and PPO networks. Members have the choice of
either a primary or a secondary network. Primary networks are like HMOs, and secondary networks
are like PPOs. In a POS plan, annual premiums and copayments are required from the members.
Although monthly premiums are higher, visits to non–network providers in the specialty fields are
an added benefit to the member with some coverage being provided by the POS plan. Structured as
a tiered plan, the POS might pay different rates for specially designated providers, regular
participating providers, and out–of–network providers according to the plans guidelines (Valerius, et
al 2008).
With Indemnity plans, all members are required to pay a premium, deductible, and coinsurance
payments. This type of plan usually pays 70% to 80% of the costs once the member's deductible has
been met for the year. In some cases, deductibles are very high so that the member's premium is
more affordable. Many indemnity plans have managed care features as well as a way for payers to
compete for employers' contracts and try to control costs (Valerius, et

How Managed Care Is A System
Managed care is a system that puts together the financing and delivery of apposite health care by
means of an all–inclusive set of services (Docteur, E., & Oxley, H. 2003).
Although, managed care can be considered an expansive term that covers many form of
organizations and insurance alternative that includes
Health Maintenance Organizations (HMOs), that provides a wide–ranging option of services, over a
period f time and at a fixed rate.
Preferred Provider Organizations (PPOs), that consist of a group of hospitals, physicians and
providers who are in agreement with an insurer, third party administrator, employer, or other group
so as to provide health care services to covered individuals;
Point–of–Service Plans (POSs), that combines the features of the HMO's and PPO's. with this plan
members can select which preference they want to use at the time of service;
Indemnity or Fee–for–Service Plans that integrates the characteristics of managed care, while
providing the benefits in a prearranged amount for covered services;
Self–Insurance Plans that allows employers and businesses assume financial liability and the
responsibilities of an insurer for their own employees.
In the last four decade, the cost of healthcare services has been on the rise, thereby leading to the
promulgation of the Health Maintenance Organization Act of 1973 (Salmon, J. W. 1995). This act
provided the opportunity to control healthcare cost, through membership of a provider network that

What Is Managed Care?
What is managed care? According to the Oxford English Dictionary, managed care is "a system of
health care in which patients agree to visit only certain doctors and hospitals, and in which the cost
of treatment is monitored by a managing company." Managed care is a variety of techniques
designed to essentially reduce the cost of providing health benefits and advance the quality of care.
In the United States alone, there are various managed care programs, that span from less restrictive
to more restrictive. As recently stated in the National Institutes of Health, the future of managed care
is uncertain. It is enthralling to note that in spite of the advances in the health care systems, such as
our hospital's ability to provide patients ... Show more content on Helpwriting.net ...
Under the HMO, each patient is appointed to a primary care physician (PCP), who is essentially
accountable for the long–term care of the members that she/he has been assigned and any specialists
that a patient needs to see should be referred by their PCP. Some examples of HMOs are Kaiser
Permanente and Humana. HMOs have been licensed at the state level, under a license that is known
as a certificate of authority. A pro of an HMO is that treatment for a patient can begin prior to their
insurance being authorized; A member may benefit from this because there would be little to no
treatment delays. A con of an HMO is that in order to save cost, most HMOs provide narrow
provider networks; A member may not benefit if in an emergency because their "in–network"
emergency room might be far or there are "quick–care" in their area. Unlike Health Maintenance
Organizations, there are managed care programs that offer a deductible, coinsurance feature and
earn money by charging a fee to the insurance company for using their network. This service is
formally known as Preferred Provider Organizations (PPO). The deductible must be fully paid
before any benefits are provided and subsequently, the coinsurance benefits will be applied. For
instance, if the PPO plan is an 80% coinsurance plan with a $1,000 deductible, then the patient will
pay 100% of the allowed provider fee up to $1,000. After this amount has

Describe And Contrast The Three Types Of Managed Care
The managed care plan coordinates the financing and delivery of health care services of its members
in order to provide the highest quality services at the lowest possible cost. These providers form the
plan network. The network have rules that determine the amount of coverage your plan will pay.
Restrictive plan cost less than flexible ones. HMOs pay provider within their network. Most
patient's care is provided y a practitioner. PPOs pay provider within their network, but also pay
provider outside their network. POS plans allow the insured to choose between an HMO or a PPO
each time care is required (MediLexicon International Ltd, 2015).
Describe and contrast the three types of managed care plans–HMOs, PPOs, and POS?
Health Maintenance

Controlling Health Care Benefits Costs
Controlling Health–Care Benefits Costs The topic that I will be discussing is Health Care Benefits
Costs. There are several different trends in the health care field that are used in business. Major
issues and obstacles are also very big regarding Health Care Benefits Costs. Controlling Health Care
Benefits Costs is a very important topic that is trending today throughout the world. Health Care
benefits costs are a "systematic approach to estimating the strengths and weaknesses of alternatives
that satisfy transactions, activities or functional requirements for a business. It is a techniques that is
used to determine options that provide the best approach for the adoption and practice in terms of
benefits in labor, time and cost savings" (Cost Benefit Analysis). Some companies compromise help
with medical costs. This depends on the company's policy. Either the employees can compensate a
fee to disregard the health care plan, while the company may choose to pay for the whole bulk of the
best. Also, the company may pay for everything. "Employers often provide employees with sort of
group medical insurance, with the level of coverage depending on the status of the employee" (Cost
Benefit Analysis). Part–time employers have less of a privilege to receive benefits than full–time
employers. "Most companies offer managed–care health coverage through HMOs and preferred
provider organizations, PPOs. HMO stands for Health Maintenance and PPO stands for Preferred
Provider

A Brief Note On The Health Care Industry

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