Fee-For-Service Health Plans Offer A Lot Of Freedom For PolicyholdersThere are many types of health insurance plans available, and one popular type is known as a fee-for-service health insurance plan. With this type of plan your insurance company will cover part of the fees that you are charged when you receive medical care. This type of policy is also referred to as a indemnity plan. A fee-for-service plan is superior to many types of health insurance policies because you get a lot of freedom when choosing health care providers and facilities. With most plans you are able to choose any doctor or hospital you want anywhere in the country.Blue Cross Blue Shield Insurance Company is one of the best-known companies that provide the fee-for-service plan. However, many other insurance carriers also provide this type of plan. It is common for this type of plan to be offered through employers or through trade associations in order for the policyholders to get group rates. Although group rates are many times available, this type of insurance policy is usually one of the most expensive types of health insurance.Most Fee-For-Service Plans Have Some Basic SimilaritiesDifferent health insurance companies set up their fee-for-service health plans differently, but most have the same basic layout. Each month the insured individual pays what is called a premium. Belonging to a group insurance plan through an employer, for example, can lower the policy’s monthly premium significantly. When you receive health care, before the insurance company pays out any money the policyholder covers a deductible.A typical insurance deductible can be between $250 and $500 and has to be met once each year. Once the yearly deductible is met, the policyholder and the insurer will share the expense of the health care. For example, the insured individual may have to pay 15 percent of the incurred medical fees, this is known as the coinsurance, and the health insurance company is responsible for the remaining 85 percent. Also, most fee-for-service health insurance plans have a cap on them. The cap is the maximum amount of money that the policyholder will have to pay out of pocket each year before the insurance company covers 100 percent of medical expenses.Fee-for-service medical plans are among the best type of medical coverage available, however many times with these plans you will need to keep good records of your medical bills, and you may be required to send forms into your insurance company before they pay out any money.
Posts Tagged ‘Plan’
What Does A Fee For Service Health Insurance Plan Entail?
Monday, June 14th, 2010Compensation Plan for Primary Care and Specialty Physicians
Tuesday, June 1st, 2010Introduction:
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Sixty-four percent of large medical groups are owned by physicians, of which physicians are employees or employee-owners. 62% of medical groups are for profit. In fully competitive market, firms want to survive by either making profit through capturing market share (market approach) or cost cutting (efficiency approach). Which ever may be the strategic posture, it should be implemented by managers, employees and labor force. Medical groups with unhealthy financial condition pose a great economic challenge in compensating physicians in a way that engages physicians in improving financial condition and as well as work environment.
A. Existing models of compensation and reimbursement for physicians:
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1. Fee-For-Service (FFS):
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It is a payment system by which doctors, hospitals and other providers are paid a specific amount for each service (diagnosis and treatment). The private and public insurers pay providers charges or claims considering discounts, allowable and provider write off, co-payment, co-insurance and deductible outstanding etc. Payment is subject to passing following validity tests:
• Patient eligibility for payment,
• Provider credentials, and
• Medical necessity.
Types of FFS:
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• Billed Charges (traditional FFS):
Some variations on FFS have developed in an attempt to provide more cost-effective and efficient care. These are discussed below:
• Fixed fee schedule: Regardless of cost of service. At time patients pay rest.
• Discount from billed charges: discounted rate for providers in PPOs.
• Relative Value Scale or Resource Based Relative Value Scale (RBRVS), developed by (CMS), formerly HCFA.
• Mandatory Reduction in All Fees: For PCPs, if budget for health plan fails.
• Budgeted Fee-For-Service: For specialists, if budget for health plan fails.
• Sliding Scale Individual Fee Allowances: Not related to budget constraint, but to individual performance.
• Case Rate, Flat Rate, or Global Fee for Procedures: all institutional cost in single package, e.g., delivery.
• Bundled Case Rate or Package Pricing: all institutional and professional components in single package, e.g., bypass surgery.
2. Capitation: its development under criticism of FFS:
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The objective of managed care is to provide necessary, quality healthcare in the most efficient and cost-effective manner. There always has been criticism against economic considerations in giving care under FFS. Physicians were criticized for excessive and unnecessary care, for example, ordering a whole battery of extra tests with unnecessary or of marginal value, to get extra fee for doing those tests. This practice increased the burden of risk of health plans. Therefore, to share this risk, with physicians by using scarce resources efficiently and cost effectively, a system of reimbursement was necessary. As a result, a new method of reimbursement, Capitation appeared that created incentives for physicians to provide quality care in the most efficient manner and possibly share in any savings.
Capitation is a dollar amount negotiated between MCOs and health care providers to cover the cost of ongoing health care delivered by a provider for a person during a specified length of time. This per capita flat or lump-sum rate of reimbursement is negotiated periodically. Under the contract, the provider is responsible for delivering or arranging the delivery of all health services required by the covered person regardless of cost.
Types of Capitation:
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• Full Risk Capitation: PMPM payment on or regardless of sex and age (includes specialists’ charges), or payment may be percentage of the insurance premium,
• Global Capitation: Include institutional and specialists’ charges,
3. Other methods for employee physicians in group:
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Staff physicians in medical group have three kinds of duties: clinical, supervisory, and administrative. We may consider two major types of model for compensating Primary care physicians (PCPs):
• Straight Salary/Base Pay:
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The physicians are employees of the health plan and receive a salary. This is typically the method of choice of staff model HMOs. Progression through salary range depends on:
o Departmental or institutional financial performance,
o Academic productivity,
o Quality, and
o Patient satisfaction.
• Incentives:
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Incentives are programs used in addition to the underlying method of provider reimbursement to provide additional inducement to the physician to practice in a particular manner. The health plan keeps the money allocated for these incentive arrangements in a separate account called a “pool”, so that the physician knows what money is available and how the health plan distributes it. It can also be distributed by provider network such as: merit pay. Incentives can modify Physician behavior to Increase productivity. Measures of individual incentive awards may include:
o Utilization management (maintaining fiscal viability and cost effectiveness of patient care).
o Productivity (individual and organization-wide).
o Work RVUs,
o Custom point systems,
o Gross revenue,
o Net collected charges, and
o Net operating income.
o Scope of practice.
o Utilization of resources.
o Quality of care provided.
o Patient satisfaction.
o Physician communications (internal with colleagues and external with patients).
o Academic performance (teaching, research), and
o Professional activities.
• Bonuses:
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The physician receives a bonus at year-end for satisfying some specific utilization or medical expenses or benchmark.
4. Incentive-plus-draw:
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• Withholds:
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To make physician aware of expenses and to practice more cost effectively, a percentage of the physician’s income is withhold to cover any excess medical expenses. The physician receives any money leftover at year-end.
• Retainer:
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Same a withhold but applicable for specialists. The purpose is different: To make specialists available when required for the members.
5. New Methods of Reimbursement
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As the healthcare industry has changed, many of the established managed care reimbursement methods have fallen out of favor or been disallowed by laws and regulations. The results are new and creative methods of compensating providers:
• Episode-Based Global Fees:
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Includes episodes of care as well as surgical procedures, such as: chronic condition of diabetes followed through the course of a year, self limiting condition of myocardial infarction involving six months of follow-up care, Or non-surgical coronary revascularization with one year of follow-up care.
• Contact Capitation:
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Specialist physician is paid a lump sum upon the physician’s first contact with a new patient for cost of care against a set ‘contact period’ (e.g., 6 or 12 months). PCP referral is still required for the initial visit – better suited for multi-specialty group.
• Market Share Capitation:
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It is better suited for single specialty group. The group gets a set percentage of capitation budgets of the health plan depending on the history of cost of care in that specialty category.
• Physician DRG:
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Physicians receive a set payment, adjusted for the severity of illness, for each Diagnosis Related Groups (DRG). If the physician provides care in a more efficient manner, the physician keeps the savings, in the same way that a hospital keeps the savings if it can reduce the length of stay in Hospital DRG.
• Direct contracting between employers and physicians with health plan in middle.
• Gain Sharing:
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Best suited to situations where the physician reimbursement is by fee schedule and the hospitals receive payment on a DRG basis. It requires the physician to consider the entire healthcare delivery system. It provides incentives for quality and cost-effective care, but is prohibited under federal programs.
• Reimbursement for Internet Consultations:
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A fixed dollar amount for keeping and updating records of chronic patients online
• Quality-Based Incentive Arrangements:
• Fee Incentive Methodology:
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Some health plans are using a flat fee methodology to change physician behavior. This methodology does not affect the underlying physician reimbursement, but it induces the physician to work in a manner that fits with the needs of the patient and the health plan.
B. Choosing methodology for reimbursement for Internists in medical groups who serve minority population:
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Factors and reality to consider before choosing a method:
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• The role clarity and work environment in medical groups which is important motivator.
• Physical infrastructure like FMIS, date collection, interpretation, communication, culture of knowledge sharing that are necessary for scanning improvement zone and closing the gap.
• The demographic and technological influence on medical group market and their unhealthy financial condition creates compelling reasons to take efficiency approach for Hispanic patients. Efficiency approach demand more focus on variable pay or reward (pay for performance and non monitory reward like time-off-the job, contests and prizes, work flexibility etc) to ensure extra effort and greater productivity (performance motivation). But to make it work, employees must see clear connection between effort, performance (expectancy), reward (instrumentality) and satisfaction (valence). This is possible if medical groups set ‘participatory SMART goal’ that is aligned with fair Performance Appraisal.
• Again, medical groups have to focus on innovative and specialty services for solvent Asian patients who are minorities too. As in medical groups physicians are employees (internists) they have to retain talents from them by appealing salary band with long term bonus, profit and/or gain sharing etc. This kind of compensation creates sense of belongingness (Membership motivation).
• The size of revenue/grant from Medicare/Medicaid – Salary arrangements are less frequent where the price of physicians’ patient care services is high and revenues from grants of Medicaid are low3.
• The local regulatory environment is also extremely important.
Objectives of reimbursement method:
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With multifaceted objectives of primary and specialty care – controlling cost and increasing profit, the best compensation plan would be that which:
• Is a market based approach to attract and retain highly qualified talent physician leaders. This retaining is necessary to compete effectively in today’s labor market.
• Can engage physicians to improve financial performance of group practice.
• Is understandable, fair and provides utmost satisfaction
Outline of possible methods:
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• No compensation model can improve financial performance in sustainable manner. However, a production driven compensation system based on work RVUs may be effective in engaging physicians to improving financial performance 1, is understandable and may provide greater satisfaction and fairness.
• Medical groups and IPAs tend to blend elements of fee-for-service, salary, and sub-capitation for their physician members, as each payment method offers advantages in terms of motivating productivity, cooperation, and practice efficiency5.
C1. Recommended methodology for reimbursement of internists in medical groups.
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For employee physicians/Internists:
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• A guaranteed base salary with cash incentives based on productivity approach (Quality-Based Incentive) could help8 with an emphasis on HEDIS measures to measure quality of care and patients’ satisfaction. This is particularly important for both Hispanic (needy) and Asian patients (educated, web-savvy, have bargaining power and insist on informed choice) who need preventive and quality care respectively. Bonus payments could be awarded on the basis of evidence in following areas7:
o Preventive care measures, such as immunizations, mammograms, etc.
o Appointment access, number of patient complaints, turnover rates,
o Clinical measures: Use of practice guidelines,
o Health Plan Employer Data Information Set (HEDIS) measures,
o Patient experience: member satisfaction surveys (satisfaction, reduction in litigation, medical costs, and timely, sustained return to work),
• In addition, non-doctors can not increase the patients and physicians base effectively. For this reason, we have to develop and nurture transactional and transformational leadership among physicians to make business success. Therefore, we have to recognize and reward talent physician leaders or go for job shadowing for prospective leaders. To encourage strong leadership skills in managerial work following rewards could be offered4:
o Stipend for managerial work above and beyond their clinical practice,
o Variable stipend–perhaps 5 to 7 percent of net income–as an incentive to grow the practice,
o Make sure that in a productivity-based system, managers are given equal credit for clinical and managerial days.
o Offer short term cash bonuses tied to meeting specific goals like quality care,
o Offer non-monetary rewards, such as: additional vacation time or relief from on-call duty, extra time off and funding for the leader to attend business conferences and seminars to learn practice-management skills. Not everybody in a firm does want direct monitory benefits/reward. Employees don’t see these benefits in terms of money. Rather, they see these as good relation and cooperation between managers that tremendously motivates them to improve productivity.
For, or office and independent PCPs:
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• We can blend reimbursement methods to fit the situations at hand. As for example, capitation basis for acute conditions and Quality-Based Incentive (bonus of FFS basis) arrangements for procedures and visits like preventive services (mammograms and vaccinations).
• Fee incentive methodology will also work. The following are some examples:
o A flat fee for each referral to a disease management program.
o A physician a higher fee schedule to increase preventive care, if the physician has high performance-based HEDIS scores.
o A flat fee for appropriate documentation of the steps taken prior to referral and/or for tracking a patient, once referral takes place.
o A flat fee for timely reporting of encounters to health plans with a small fee per record reported.
Risk adjustment:
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This will be done through continuous process and procedural improvement that tracts data and records of outcome and invigorating a culture of sharing knowledge (both bilateral and within groups). Sharing information will find the improvement zone and quickly improve the quality of care. In this situation, internists should not be penalized for receiving sick patients by withholds. Otherwise, they may refuse sick patients or refer them to other docs that may end up in loosing health plans and market share.
C2. Methodology for reimbursement for specialists in medical groups:
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a. Market Share Capitation (sub capitation):
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If a specialty group sees 20% of the patients who require that type of specialist in a year, that specialty group will receive 20% of the monthly capitation budget for that specialty. This method is only appropriate for single specialty groups. Individual doctors in multi-specialty groups do not have enough share of the market for the method to work. This method relies on historical referral patterns on which to base payments. New physician groups that do not have this history usually receive fee-for-service payments until they establish a referral history. Market share capitation is less difficult to administer than contact capitation because there are fewer items to track.
b. Contact capitation:
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Capitation in its true form does not work well with specialty physicians, because low dollars are associated with capitation contracts for specialists. Consequently, reimbursement for most specialists is on a discounted FFS basis. Contact capitation modifies traditional capitation to better suit the circumstances of specialty physicians. To ensure fair compensation for variations in severity of illness, risk is adjusted in following ways:
? Certain diagnoses or procedures may carry higher contact weights.
? Selected subspecialties and/or procedures may be covered separately.
? Separate capitation rates may be developed for different age segments.
? The sickest patients or patients with particularly difficult diagnoses may be carved out and paid on a fee-for-service basis.
Contact capitation fits with the objectives of managed care, because it creates incentives for physicians to manage patient care as efficiently and effectively as possible. Keeping patients healthy by disease management and patient treatment compliance reduces the need for additional visits that may not result in additional revenue.
D. Future reimbursement methods in medical groups:
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Global capitation:
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Medical groups have both hospital in-patient and out-patient care. On the background of more stricture by HMOs, if these groups integrates vertically11 and form alliance with physicians and if legislation permits, a global capitation (covers both institutional and specialty cost) may help.
Global Fees or Case Rates:
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Medical groups may integrate horizontally to provide on-stop service (focus factories12) on a particular disease to indicate value for money as because:
• Hispanic population is increasing, is more prone to chronic conditions including cancers and
• Employers are carefully observing situation in health care market and is inclined to opt for defined contribution.
These focused factories can provide all the care necessary for a particular disease (such as breast cancer); therefore, case rates, or episode-based global fees, would seem to be the ideal way to reimburse the providers in these situations.
E. Success of the models:
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To succeed, Medical groups may receive capitation from their contracting health plans and then sub-capitate their physicians and hospitals9, 10. But capitation doesn’t always bring about success. In addition to a better payment structure, these groups should have to develop core competence. They should follow the following steps to succeed:
• First, collect data on practice patterns, outcomes, quality of care, and other performance measures. Share this information with physicians. This would promote positive change. The more information on outcome brought to the negotiating table, the better able medical groups will be to negotiate fair contracts. Therefore, these groups should invest in the information system: both management and financial. This involves a large initial investment, but it is imperative to an organization’s success.
• Second, provide financial incentives to the physicians in the group by sub-capitation or emphasize on the importance of a fair and equitable compensation system that provides the correct types of incentives. To succeed, it is imperative to have financial incentives that induce behavior consistent with the goals of the group (i.e., quality care with little waste).
• Third, use standard care guidelines or pathways. These guidelines allow the group to provide improved quality of care at reduced cost because the “fat”, or unnecessary steps, is removed from the process.
• Fourth, build close relationships with key players in the market. This includes health plans, insurance companies, and PCPs. Oncologists rely on PCPs for referrals, so good relationships are vital.
• Fifth, develop and retain transactional and transformational leadership within physicians who enjoy taking managerial responsibility in addition to their own practice.
• Sixth, risk and responsibility must be balanced between the health plan and the provider. The physician should only take on risk for that over which, he has control. The secret to success is to accept only as much risk as can be handled by the group and to make sure they have the right people advising them on how to handle the risk.
• Finally, medical groups should develop a clear vision and mission to support good and quality work with fair and equitable incentive and would not support bad outcome and environment.
Conclusion:
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The success or failure of a particular reimbursement method doesn’t only depend on the method we use; but also depend on how strong financially the medical groups are and how organized they are in terms of human and structural asset and supportive working environment.
Article Source: http://www.articlesbasecamp.com
1. Physician Compensation Models in Large Medical Groups:Nov. – Dec. 2001, By Jennifer Nelson, Carleton T. Rider, John E. Biermann, and Shawn D. Schwartz www.nejmjobs.org/rpt/physician-compensation.aspx. 2. Arch Intern Med. 2006;166:623-628. Available pre-embargo to the media at www.jamamedia.org 3. links.jstor.org/sici?sici=0361-915X%28198121%2912%3A1%3C155%3ACABHAP%3E2.0.CO%3B2-8&size=SMALL
Coping With Large Medical Bills And Debt With A Payment Plan
Tuesday, May 4th, 2010Medical bills and debts are ineluctable in everyone’s life. But excess payment from our hands can be fended off always. To begin with, you need to check the bills because sometimes you might be overcharged for some drugs. Also doctors prefer medicines which will give them profit. So, you can go for alternative drugs having same impact and effect for which it is prescribed. This should be done after gaining sufficient knowledge and consulting doctor.
Haggle for better costs on medicines. This needs a lot of home work to be done because you need a proper knowledge on the prices of medicines. Lot of sources are available if you browse through internet. Even many insurance providers will have some data on the cost of the medical items.
Also ensure that all the pending payments do not come under the insurance provider. You have to review it carefully. Also you can avail help from the American Academy of Family physicians to understand the billing statements and to gain knowledge on various benefits that you can acquire from the insurance provider. The Bureau of Consumer Protection can assist you in solving disputes.
With all these precautionary measures executed, you can proceed further to prepare a flow chart of your payment plan. The first step is to negotiate with the creditors. They can help you with appreciable discounts for one time payments. Also you can go for payment on a monthly basis. In such case, negotiate for lower interest rates.
Get aid from the charitable or financial aid department associated with every hospital. They can assist you to a greater extent if you are really suffering from financial compaction. To avoid adverse actions to be taken against you, you need to keep in touch with the creditors. Do not avoid any bills from the hospitals or creditors. Better negotiate rather than avoiding. Many social and federal organisations can provide medical debt grants for the sufferers. Do not pay your bills through credit cards which may have steeper interest rates. Get help from Medical debt counsellors to arrive for a quicker solution.
If a collection agency contacts you, it will lead to poor credit score. Make a proper plan on your budget. Arrive at your monthly instalments and inform them legitimately. Travel behind your plan to get rid of tough time in your life.
What You Need To Know About Home Mortgage Payment Protection Plan
Monday, April 19th, 2010Because of unfortunate circumstances such as accidents and physical disability, any individual can, at worst, find himself jobless and at best, with a decreased income. It is in these instances though that medical expenses and hospital bills are likely to increase. There is a way to deal with expenses incurred by unforeseen happenings.Mortgage life protection and mortgage payment protection are the two types of insurance. Mortgage life protection covers payments in your mortgage in the event of your death. On the other hand, mortgage payment covers monthly payments in the event that you lose your job or become gravely ill.How does home mortgage payment protection work?You make your payments (which are tax-deductible) to your creditor, and receive benefits that are paid along with other benefits. Premiums are pre-calculated in association with the decreasing death benefit, so they stay fixed. The rate provided by a policy can vary depending on different factors like how old you are and if you are a smoker or not. Advantages:There are many advantages of mortgage life insurance and one of them is that it offers you an affordable means to give your family protection and security while paying off your mortgage balance if death occurs. This insurance can give your family the benefit of spending for other living necessities and personal expenses. In its essence, mortgage protection involves you paying a fixed premium during a period of time and your insurance pays off your mortgage at the event of unemployment, illness or death. Here are the advantages:- Affordable and optimal coverage – Flexible policies – Financial difficulties are eased – Policies have fixed premiums for everyone and are available to younger individuals, who have tighter budgets – You can have control over the pre-payment of your mortgage – Mortgage payment protection gives you time to regain employment. The state will no longer aid those who have lost their jobs – Even if your mortgage has already been paid off, your beneficiaries can still receive remaining death benefits – You can reissue your mortgage protection policy if you refinance your mortgage.Who Qualifies?- Almost anyone qualifies for a protection plan, no matter what sex or age – You are able to obtain joint coverage for you and your spouseWhere To Get Home Mortgage Payment Protection Insurance:- Establishments that organizes your mortgage – You can get mortgage life insurance through your mortgage lender at a cheaper rate. What You Want To Do:- Start saving larger amounts of mortgage interest – Own your own home at a sooner timeDownsides:Mortgage life insurance pays for the mortgage in the event of the individuals death while private mortgage insurance allows them to keep their homes. Mortgage protection coverage pays only your mortgage balance. If you default, private mortgage insurance only partially covers your loan.Some expenses, charges and risks are involved with some types of life insurance because they can be sold by prospectus. Review pamphlets carefully before jumping into an investment or plan. It is always best to contact with your tax advisor or attorney for information that is free and does not require commitment.
Look for the Best Florida Health Insurance Coverage at Plan Rover
Sunday, April 11th, 2010There are some individuals who think that health insurance is not that beneficial. For them, paying for insurance coverage should not be high on their list of finances. They do not want to place their hard-earned income on something which they are not certain that they could use. However, you should know that this is as important as getting a loan for your new home. Accidents happen all the time. You do not know when something might befall upon you or on one of your family members. There are a lot of misfortunes which need medical assistance. Hospital bills can take a chunk out of your savings if you are not prepared for instances like these. The best way for you to prepare would be to buy insurance coverage. If you do not have coverage policies or you have not been provided by your employer with these, it will be hard for you to deal with the expenses.
Whether you are searching for Florida group insurance or individual health insurance, you will be able to find an insurance company which can provide you with the best rates. When you want to obtain quotes from various companies, you can choose to contact their service desks and inquire. On the other hand, you can look for insurance groups over at the Internet. However, searching individually for companies which offer Florida health insurance can take so much of your time. There is one way for you to make this process simple. This is possible through Plan Rover, which is a local insurance agent. This website does not sell insurance coverage. What it does though, is help you search for the best insurance rates so that you will be able to find an affordable Florida group health insurance.
Plan Rover uses the latest web technology to help you obtain Florida health insurance quote. This local agent provides you with advanced and effective insurance quoting and processing tools. Through these tools, you will be able to replace your insurance with new policies or buy new coverage if you do not have one yet. The department of insurance in Florida files and regulates the rates of all health insurance companies within the state. If you have found a health insurance package which fits your income and lifestyle well, you can choose to purchase this from Plan Rover. Or else, you can buy this directly from the insurance group that you have chosen. Either way, the monthly premium that you will be paying for the plan is similar.
Whether you are searching for Florida individual health insurance or you want to buy coverage for the employees of your small company, opt to look up rates at Plan Rover. This local insurance agent will serve as your guide when you are looking into the rates of several insurance groups. If you are hunting for small business health insurance, Florida provides you with group health insurance and dental insurance. On the other hand, individual and family insurance coverage includes dental insurance, student health insurance, and individual health insurance among others.
The middle-rate plan for hospital patients;: A year’s experiment in Keokuk, Iowa,
Thursday, April 8th, 2010Health plan kickoff clause going.
Friday, April 2nd, 2010Product Description
This digital document is an article from The Register-Guard (Eugene, OR), published by Thomson Gale on April 27, 2006. The length of the article is 695 words. The page length shown above is based on a typical 300-word page. The article is delivered in HTML format and is available in your Amazon.com Digital Locker immediately after purchase. You can view it with any web browser.
Citation Details
Title: Health plan kickoff clause going.(Government)(The provision that removed poor people for missing a monthly fee will end June 1)
Publication: The Register-Guard (Eugene, OR) (Newspaper)
Date: April 27, 2006
Publisher: Thomson Gale
Page: C1
Distributed by Thomson Gale
Apply For Medigap Insurance Which Will Cover Your Previous Medicare Plan
Monday, March 22nd, 2010Medicare original policy does not always provide you your necessity as there is always some unpaid calculations. These calculations may place you in uncomfortable positions when you have to pay the extra money from your own purse. This is one of the problems you may face when you would claim your health insurance money at the time of your treatment period. There are some money which you will not get and have to give your instead. Medicare original plan is all about that. But it is not unsolvable as there are many private companies which have launched Medicare supplemental policy to support or supplement this original health plan. You will get your full coverage if you have applied for this Medicare supplemental health insurance after doing an original one. This policy is called as medigap insurance health plan. Medigap correctly refers to its action and purpose of serving. It covers the gaps between the Medicare original policy and the insurance coverage it really does. Medigap health insurance plans are governed by private companies and not have any link to government body.Though these polices are governed by private bodies but there are still some definite rules those have to follow by all companies. As for example the companies can only offer 12 standard Medigap insurance plans named A through L. And it is also to be mentioned that the plans under the same letter cover is bound to provide same benefits irrespective of the companies selling them. What they could differ from each other is the amount of insurance premium. Part A Medigap health insurance plan is your hospital insurance. Part B is that part of the insurance coverage that helps you pay for the medical services that are not covered by the Part A policy. These rules include the same amount of premiums should be drawn from the policy holder. All the plans should be same with same benefits. According to the law the private insurance companies can offer only twelve standard Medicare Supplement Insurance Plans, named A through L. each of these plans have their own set of benefits, different from the others. However, almost all of the twelve Medigap insurance plans provide the basic benefits of Medicare part A and B.Therefore it is always recommended to study all the Medigap insurance plans before deciding to choose the one that would fit the best for you. Besides that the fact that should be kept in mind is that, no matter from whatever insurance company you may purchase a particular plan, all of the plans with the same letter cover must provide the same benefits. As for example if you purchase a Medigap plan C policy, it should cover the same benefits without depending on the company that is selling the plan. However, the premium rates may vary for different companies. Therefore you are free to purchase any Medigap insurance from the company you like and be sure to get the same benefits provided by the other companies.
Hospital employees’ health plan in limbo
Thursday, March 4th, 2010Medical Mutual of Ohio’s decision to drop Premier Health Partners from its network has left one Premier hospital, Upper Valley Medical Center, in limbo.Medical Mutual is the sole third-party administrator of the Miami County health system’s self-insured health plan.Mike Maiberger, UVMC’s president and CEO, said in a prepared statement Wednesday, Nov. 11, that UVMC is in the process of putting a plan in place “to ensure that UVMC employees will have the same, or a very similar, health insurance plan with another third-party administrator in the event that we are unable to reach an agreement with Medical Mutual.”UVMC is Miami County’s largest employer. The decision affects 1,120 UVMC employees, plus 12 retirees who received health-care benefits as part of an early-retirement package in the 1990s. Employees were told of the decision Tuesday through a newsletter, hospital spokeswoman Gail Peterson said.Medical Mutual confirmed Tuesday that it is terminating its agreement with Premier as of Jan. 1, 2010.Ed Byers, Medical Mutual’s manager of media relations, said Wednesday that no plans to resume negotiations with Premier have been made. Medical Mutual received about 100 calls Wednesday from Dayton-area members seeking more information, he said. Medical Mutual members may call (877) 328-6664.Premier spokeswoman Diane Ewing had said Tuesday that Premier’s proposed reimbursement rate for Upper Valley Medical Center was significantly less than those proposed for Premier’s other three hospitals: Miami Valley and Good Samaritan hospitals, and Atrium Medical Center. On Wednesday, Ewing said the lower proposed reimbursement rate for UVMC was not related to the fact that Medical Mutual is UVMC’s sole third-party administrator.Medical Mutual is the third insurer to drop Premier Health Partners in the past five years. Humana Inc. dropped Premier a year ago, and Premier and Anthem were separated for one year after a contract showdown in late 2004. Premier rejoined the Anthem network in 2006.
Doctor launches firm to help patients cut big hospital bills: the plan: reduced rates for promised prompt payment. (David Thomas of Patients Hospital Discount … An article from: San Diego Business Journal
Friday, February 26th, 2010Product Description
This digital document is an article from San Diego Business Journal, published by CBJ, L.P. on March 4, 1991. The length of the article is 887 words. The page length shown above is based on a typical 300-word page. The article is delivered in HTML format and is available in your Amazon.com Digital Locker immediately after purchase. You can view it with any web browser.
Citation Details
Title: Doctor launches firm to help patients cut big hospital bills: the plan: reduced rates for promised prompt payment. (David Thomas of Patients Hospital Discount Contracting Service)
Author: Bradley J. Fikes
Publication: San Diego Business Journal (Magazine/Journal)
Date: March 4, 1991
Publisher: CBJ, L.P.
Volume: v12 Issue: n9 Page: p8(1)
Distributed by Thomson Gale
