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Hcr 230/Week 1 Essay

528 words - 3 pages

There are many choices before picking Private payers or Consumer-Driven Health Plans. Private payers have plans such as PPO’s, HMO’s, and Group HMO’s, IPA’s, POS’s, and Indemnity plans. Consumer-Driven Health Plans are like a free will plans because a consumer can have options to build their own plans depending on their financial situation with saving account options. Learning about each health plan and identifying each feature, since there are many options available for health care coverage.

Private plans have different types of plans and products. Preferred Provider Organizations (PPO) is a discounted fee-for-services. Consumers pay an annual premium and a deductible. Co-pays are paid at time of services, and pay the yearly deductible out of ...view middle of the document...

If the patient needs to see a specialist, it needs to be in the patient contracted medical group. If the consumer goes out of network, the HMO will not pay for any services and is left for the consumer. Emergencies are the only exception. Consumers pay co-pays and premiums for office visits. Under HMO, consumers do not have to pay out of pocket but may have to pay for a deductible. Point-of-Service (POS) plan is a hybrid of HMO and PPO networks. Consumers can choose where to receive services. They can go in or out of network. Premiums are more costly than other plans, but the benefit of seeing any medical provider without permission. Consumers have to pay higher co-pays and deductibles. . (Valerius, Bayes, Newby, Seggern , 2008). Group HMO is contract with more than one physician group. Consumers receive services with in the HMO’s facilities. Physicians are paid salary by the HMO, depending on the number of patient per services the HMO will pay per member per service. Independent Physicians Association (IPA) are part of the Group HMO because it is a group of individual private practices physicians that are contracted with HMO health plans to provided services. HMO pays negotiated fees for medical services to the IPA, then IPA pays the physicians by a capitated rate or a fee. (Valerius, Bayes, Newby, Seggern , 2008). Indemnity plans is a fee-for—services. Plans that generally assume the medical profession will be paid a fee for each service provided to the patients. Consumer are able pick any doctor, then a claim is filed by either the provider or the patient. Covered medical services will be reimbursed. Anything that was not covered will the responsibility of the patient to pay.

Consumer-Driven Health Plans (CDHPs) is

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