Reviewing An Insurance Reimbursement Method Essay

Reviewing An Insurance Reimbursement Method Essay

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In this week’s discussion we are tasked with discussing an insurance reimbursement method. The insurance reimbursement method I was assigned to is the fee-for-service, commonly referred to as (FFS). The FFS is described as services that are individually billed, for example; in January I had an endoscopy exam where the physician viewed the inside of my stomach with a scope; before the exam took place they completed routine lab work, gave me anesthesia, completed the endoscopy, and took a biopsy of my stomach; in addition, they used the hospitals facility.

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.

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