Health Insurance Matrix - 3133 Words

University of Phoenix Material Health Insurance Matrix As you learn about health care delivery in the United States, it is important to understand the various models of health insurance to develop a working knowledge as you progress through the course. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers as important foundational information for your role as a future health care worker. Fill in the following matrix. Each box must contain responses between 50 and 100 words using complete sentences. Include APA citations for the content you provide. Origin: When was the model first used? What kind of†¦show more content†¦Indemnity health plans run on a retrospective payment system. A member has a monthly premium. Co-pays and a deductible. Upon visits the provider submits claims for services rendered to the insurance company, upon which the insurance company pays their part and the member is billed for the remaining balance to be paid out-of-pocket. With indemnity plans employers deduct the monthly premium from payroll of each employee on the plan. Both the member and the insurance company pay for services rendered. Upon receipt of the services the insurer pays the provider their portion if the deductible has been met. The member is then responsible for the remaining balance and the co-pay at the time of service. The structure of an indemnity plan is completely â€Å"open access†. The member may choose any provider or specialist they would like. In an indemnity plan there are no restrictions on providers or provider type. It is the member’s responsibility to seek and sign on with their preferred provider or specialist. Positive aspects of indemnity plans include the liberty of the member to choose their preferred provider or specialist and their preference of type of care they wish to receive. A negative aspect of indemnity plans from a members stand point is the cost of these plans. Premiums and deductibles then to be higher with indemnity plans over other insurance plans due to the freedomShow MoreRelatedHealth Insurance Matrix Essay2138 Words   |  9 Pagesï » ¿ University of Phoenix Material Health Insurance Matrix Origin: When was the model first used? What kind of payment system is used, such as prospective, retrospective, or concurrent? Who pays for care? What is the access structure, such as gatekeeper, open-access, and so forth? How does the model affect patients? Include pros and cons. How does the model affect providers? Include pros and cons. Indemnity In 1932 the American Medical Association (AMA) adopted a strong positionRead Morehealth insurance matrix HCS/235 Essay637 Words   |  3 PagesMaterial Health Insurance Matrix As you learn about health care delivery in the United States, it is important to understand the various models of health insurance to develop a working knowledge as you progress through the course. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers as important foundational information for your role as a future health care workerRead More HCS 235 Week 2 Completed Health insurance matrix1163 Words   |  5 PagesMaterial Health Insurance Matrix As you learn about health care delivery in the United States, it is important to understand the various models of health insurance to develop a working knowledge as you progress through the course. 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Samaritan Health System dates back to 1911 that covered California and Arizona, primarilyRead MoreThe Shift Of The Affordable Care Act ( Aca )1100 Words   |  5 Pagesof different payment and reimbursement options, health insurance programs, and the establishment of the Affordable Care Act (ACA). Between May 2009 and April 2012, one of the initial PCMH pilot programs was conducted in Colorado, appropriately named The Colorado Multipayer Patient-Centered Medical Home Pilot. More than 100,000 patients within sixteen internal medicine practices participated in the experimental PCMH model, using six different health plans (Harbrecht Latts, 2012). When the pilot