I paid a co-pay of $250.00; Initially I was under the impression that my copay covered all the services (this was before I completed the intake documents (patient documents) on the day of service. 30 days later I received a bill for each service completed lab work, anesthesia, physician bill, a bill for the biopsy that was taken, and a bill for facility use. This is a prime example of FFS model of payment. Although I have been in the health care industry eight years, this is where I got a clear understanding of my insurance and what fee-for-service was.
Why is the United Healthcare System based on this model and why do I think it is best? According to the text the FFS model is the best way for physicians to provide additional services (even if they are not needed), the FFS model enables the physician to rule out problematic diseases by allowing them perform additional services. In the long run it is possible that the FFS model is more beneficial to a patient since this model allows for the physician to request additional testing along with a routine visit. What we may view as unnecessary testing just might save one’s life.
Alternatively, the capitation payment system is ...
... middle of paper ...
...t problem; thereafter, finding the issue early and prescribing medication, Trevor could have avoided the hospital visit and admission which helps keep health care cost to a minimum.
Although the FFS model may have a larger out-of-pocket expense, I must conclude the FFS is the best model, FFS allows the physician to complete routine exams, add additional services without a pre-authorization (meaning the patient do not have to wait for some services to be authorized and services, and testing can be completed instantaneously). The FFS model allows for the patient to choose its provider and the provider can be alternated at any time and usually the deductible covers the yearly fees once it is satisfied. Additionally, the primary care physician does not play the role of the Gatekeeper. If the patient wanted to go directly to a specialist, they are able to do just that.
Need Writing Help?
Get feedback on grammar, clarity, concision and logic instantly.Check your paper »
- Introduction The current health care reimbursement system in the United State is not cost effective, and politicians, along with insurance companies, are searching for a new reimbursement model. A new health care arrangement, value based health care, seems to be gaining momentum with help from the biggest piece of health care legislation within the last decade; the Affordable Care Act is pushing the health care system to adopt this arrangement. However, the community of health care providers is attempting to slow the momentum of the value based health care, because they wish to maintain their autonomy under the current fee-for-service reimbursement system (FFS). FFS is an arrangement under... [tags: Health care, Health economics, Health insurance]
887 words (2.5 pages)
- Pay-for-performance (P4P) is the compensation representation that compensates healthcare contributors for accomplishing pre-authorized objectives for the delivery of quality health care assistance by economic incentives. P4P is increasingly put into practice in the healthcare structure to support quality enhancements in healthcare systems. Thus, pay-for-performance can be seen as a means of attaching financial incentives to the main objectives of clinical care. However, reimbursement is a managed care payment by a third party to a beneficiary, hospital or other health care providers for services rendered to an insured or beneficiary.... [tags: P4P in Healthcare Industry]
1964 words (5.6 pages)
- LRC Health Insurance: Tricare Coding Classifications & Reimbursement Systems, MDA1305 TRICARE formerly known as CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) is a federal healthcare program implemented in 1967 for active duty military members and their dependent family members. TRICARE is also for retirees of the military and their dependent family members and for survivors of soldiers who died while serving. U.S. uniform services include: Army, Navy, Air force, Marines, Coast Guard, Public Health Service, and National Oceanic and Atmospheric Administration (NOAA) (Rowell, J.... [tags: Coding Classifications, Reimbursement Systems]
1043 words (3 pages)
- Nothing is free. You pay either price or tax for the air you breathe, no way can you get health care free of cost. Health insurance is a way to pay the cost for health care. Most people cannot afford to pay the high cost of health care on their own and that’s where the insurance comes in. It simply a protection from paying the full cost of medical services when you’re not well. The payment is in the form of monthly premium. People have freedom to select the plan from different insurer in the health insurance market and pay decided fix amount as a premium.... [tags: Health insurance, Health care, Insurance]
1644 words (4.7 pages)
- ... The median depends on if the middle is an odd or even number. If it is an odd number then that will be the median. If it is even number, then you add the two even numbers together and divide by the total number of all the values to get the median. The descriptive statistic analysis from Excel shows the median for prospecting methods are referrals 7, Cold Calling 3, and Sales Leads 6. The mode is whichever value is used the most, which are 9, 3, and 6 for the three prospecting methods. To find the range is the difference between the largest and smallest value in the data set which also can be found in the descriptive analysis in Appendix A.... [tags: insurance professionals business]
1659 words (4.7 pages)
- Healthcare industry is extremely expensive to maintain and operate. Each facility has to purchase equipment, billing systems, electricity, etc. to provide care to patients. Not only does the facilities have to provide material items, but most importantly payroll for staff such as doctors, nurses, and billers. All these mention cost money. Therefore doctors’ bill charges for their procedures and services they provide. It is the responsibility of insurance carriers and patients to reimburse for the charges rendered.... [tags: Health care, Health insurance, Insurance, Medicine]
951 words (2.7 pages)
- At present, healthcare expenditures in the United States are about nineteen percent of the gross domestic product, according to Hicks, 2014. Concerns raised with the soaring health care spending that further adds to the country’s GDP, and the health care cost has on physician performance. Addressing these concerns could lead to lowering the cost of health care and making it affordable for those who are uninsured. The two systems that dominate the reimbursement schedule are Capitation and Fee-for-service each function according to risk, either malpractice or aversion (Hicks, 2014).... [tags: Health care, Health economics, Medicine]
1003 words (2.9 pages)
- Reviewing the Significance and Essentials of the Review of Literature Reviews of literature, also knows as a literature reviews, are commonly found in significant research writing projects including articles, theses, and studies. If the researcher neglects to include a review of literature in his or her project, he or she is leaving out an essential element that will lead to a lesser quality research project. In determining its importance, it is necessary to examine the definition, elements, and significance of the review of literature.... [tags: Research, Scientific method, Academic publishing]
1288 words (3.7 pages)
- Introduction Insurance is a very important part of modern life and business. In this paper I will discuss the basic concepts of insurance, claims-made and occurrence liability policies, factors for selecting an insurance company and policies, and the difference between workers compensation and liability insurance. What is insurance. Insurance is a two-way legal agreement between the insurer and the customer. The customer, which may be an individual, business, or other entity, agrees to pay the premiums as required, in exchange for monetary protection from the insurer for any possible substantial loss.... [tags: Insurance]
837 words (2.4 pages)
- As human beings, we all have basic needs that include both physical and economic security, food, shelter, and clothing. According to the Society of Actuaries, risk is the possibility of losing economic security. We encounter many economic risks throughout our day to day activities; whether the risk is a car accident, sickness, house fire, or even death. For such reasons, insurance was created to eliminate risk or substitute certainty for uncertainty. The concept of insurance dates back to at least 3000 B.C.... [tags: Insurance ]
932 words (2.7 pages)