Hcr 230 Week 1 Assignment Features of Private Payers and Consumer Driven Health Plans
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HCR 230 Week 1 Assignment Features of Private Payers and Consumer Driven Health Plans
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Features of Private Payer and Consumer-Driven Health Plans
PPOs will pay participating contributors established on a discount from their physician fee schedules, called discounted fee-for-service. Under the PPO’s, the patient has to pay an annual premium and frequently a deductible. A PPO plan may propose either a lower deductible with a higher insurance payment or a high deductible with a lower premium. Covered members remit a copayment at the time of each medical service. Each individual may also have a per annual deductible to pay out-of-pocket. A patient may see an out-of-network doctor requiring a referral or preauthorization, but the deductible for out-of-network services may be higher, and the percentage plan will pay may be lower (Valerius, Bayes, Newby, Seggern, 2008).
Healthcare organizations were initially intended to protect all basic services for an annual premium and visit copayments. This contract is called “first-dollar coverage” considering that no deductible is needed and patients do not make out-of-pocket payments. On account of expenses, still, HMOs may at the present time assign deductibles to family coverage, and employer-sponsored HMOs are also starting to restore copayment with coinsurance for some services (Valerius, Bayes, Newby, Seggern, 2008).
HCR 230 Week 1 Assignment Features of Private Payers and Consumer Driven Health Plans
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