Short Paper 2 Managed care is constantly progressive. It is a field that is continually evolving. At the far left of the continuum of managed care lies managed indemnity and to the far right is closed panel HMOs. When we talk about the continuum of managed care we are referring to “clinical or operational improvements to the overall delivery of care.”(Bharucha, 2012) Moving towards the right of the continuum the main goal is to provide better quality, service and lower costs. According to Kongstvedt, “these key features appear as you begin to move toward the managed care end of the continuum: tighter elements of control over health care delivery, addition of new elements of control, more direct interaction with providers, increased overhead
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Indemnity insurance, generally has no restrictions to who the insured can seek care. There is a deductible and if you are billed any charges that the provider does not cover, you are responsible for that charge. Precertification for hospitals is mandatory, otherwise the insured will suffer financial consequences. Life is quite uncertain, say you were involved in a traumatic automobile accident, case management will be able to help you with the cost. If your physician sternly suggests that you should undergo surgery because you are extremely obese, a second opinion is usually mandatory. The key elements of a service plan are: the organization agrees to pay the provider directly, the provider cannot bill the insurance company for something not made by the plan, allows the plan to audit the provider’s records, also requires precertification, case management and second …show more content…
The key element in POS is that you are able to see a provider that is in the network or not for a reduced level of coverage. According to Kongstvedt “The difference between coverage for in-network services and out of network services generally ranges from 20-40 percent.”(2009, p.31) Health maintenance organizations provide less freedom to choose. HMOs are more restricted but strives to meet the quality standards. For example, a physical or general health check, you’re probably only allowed one a year, I mean you could get ten done, but the HMO will only cover one of those visits. One of the important elements of HMOs is selecting a primary care provider, this person will determine all your needs and be able to refer you if you need any special treatment done. HMOs most of the time are generally less costly, but then again there is a tradeoff between price and
Indemnity insurance, generally has no restrictions to who the insured can seek care. There is a deductible and if you are billed any charges that the provider does not cover, you are responsible for that charge. Precertification for hospitals is mandatory, otherwise the insured will suffer financial consequences. Life is quite uncertain, say you were involved in a traumatic automobile accident, case management will be able to help you with the cost. If your physician sternly suggests that you should undergo surgery because you are extremely obese, a second opinion is usually mandatory. The key elements of a service plan are: the organization agrees to pay the provider directly, the provider cannot bill the insurance company for something not made by the plan, allows the plan to audit the provider’s records, also requires precertification, case management and second …show more content…
The key element in POS is that you are able to see a provider that is in the network or not for a reduced level of coverage. According to Kongstvedt “The difference between coverage for in-network services and out of network services generally ranges from 20-40 percent.”(2009, p.31) Health maintenance organizations provide less freedom to choose. HMOs are more restricted but strives to meet the quality standards. For example, a physical or general health check, you’re probably only allowed one a year, I mean you could get ten done, but the HMO will only cover one of those visits. One of the important elements of HMOs is selecting a primary care provider, this person will determine all your needs and be able to refer you if you need any special treatment done. HMOs most of the time are generally less costly, but then again there is a tradeoff between price and