Health Care Plans
Define, compare and contrast fee-for-service and managed health care plans. What are the similarities and differences? Support your response with one citation and specific examples.
Fee-for-Service Plans This type of health insurance program provides protection against health care expenses in the form of a cash benefit paid to the insured or directly to the health care provider after the employee has received health care services (Martocchio, 2014, p. 145). This means that the employee pays for the services rendered such as, hospital expenses, surgical expenses and physician charges, and the program pays benefits on a reimbursement basis. Furthermore, policyholders may have the option to select any specific licensed physician, surgeon, or medical facility for treatment, instead of using a particular network of individuals coved under the program. There are two types of fee-for-service health care programs available, which include indemnity plans, and self-funded plans. The main difference between the two insurance plans offed by independent insurance companies and self-funded insurance plans center on how benefits provided to policyholder are financed (Martocchio, 2014, p. 145). Although there are similarities and …show more content…
These plans were created to create a more cost effective and efficient way to control health care by imposing substantial restrictions on an employee’s ability to make choices about whom they could receive medical treatment from. Moreover, this program enforced a barrier, which created a gatekeeper role of primary care physicians, and mandated the level of benefits they could receive based on designated in-and non-network providers (Martocchio, 2014, p. 155). After a company elects to utilize managed care plans, there generally select one of three types of coverage they can choose from to accommodate the needs of their
Define, compare and contrast fee-for-service and managed health care plans. What are the similarities and differences? Support your response with one citation and specific examples.
Fee-for-Service Plans This type of health insurance program provides protection against health care expenses in the form of a cash benefit paid to the insured or directly to the health care provider after the employee has received health care services (Martocchio, 2014, p. 145). This means that the employee pays for the services rendered such as, hospital expenses, surgical expenses and physician charges, and the program pays benefits on a reimbursement basis. Furthermore, policyholders may have the option to select any specific licensed physician, surgeon, or medical facility for treatment, instead of using a particular network of individuals coved under the program. There are two types of fee-for-service health care programs available, which include indemnity plans, and self-funded plans. The main difference between the two insurance plans offed by independent insurance companies and self-funded insurance plans center on how benefits provided to policyholder are financed (Martocchio, 2014, p. 145). Although there are similarities and …show more content…
These plans were created to create a more cost effective and efficient way to control health care by imposing substantial restrictions on an employee’s ability to make choices about whom they could receive medical treatment from. Moreover, this program enforced a barrier, which created a gatekeeper role of primary care physicians, and mandated the level of benefits they could receive based on designated in-and non-network providers (Martocchio, 2014, p. 155). After a company elects to utilize managed care plans, there generally select one of three types of coverage they can choose from to accommodate the needs of their