Private Insurance Presentation by Bri Pinkston https://padlet.com/bripinkston20171/98h1uyhil87mfckp Alex, Bri, Ryan en-us 2020-10-12 18:43:30 UTC 2024-10-17 07:17:42 UTC hello@padlet.com Conventional Indemnity bripinkston20171 https://padlet.com/bripinkston20171/98h1uyhil87mfckp/wish/822613299 Most indemnity insurance products are based on the fee-for-service model. When insured individuals utilize health care services, they pay for those services and seek reimbursement from the insurer. Care is rendered by independent health care providers, without gatekeeping or other restrictions. Management of care only comes into play in elective admissions, which may require preauthorization. While this type of coverage used to be predominant in the health insurance industry, it now represents only a very small segment of the market (less than 1% in 2018) (Buchbinder pg. 199).]]> 2020-10-12 18:51:12 UTC https://padlet.com/bripinkston20171/98h1uyhil87mfckp/wish/822613299 HMO amstransky16 https://padlet.com/bripinkston20171/98h1uyhil87mfckp/wish/822622063 An HMO, or Home Maintenance Organization, allows individuals to become members of the organization by paying a fixed prepayment amount. (Hayes, 2020) 

These plans provide some flexibility to the HMO model described above and are sometimes referred to as open-ended plans  (Hayes, 2020) . Under a POS plan, an enrollee can use services that are out of plan, in exchange for deductibles and coinsurance payments  (Hayes, 2020) . The plan tries to address some of the shortcomings of the pure HMO approach  (Hayes, 2020).]]> 2020-10-12 18:54:29 UTC https://padlet.com/bripinkston20171/98h1uyhil87mfckp/wish/822622063 Point-of-Service (POS) Plans bripinkston20171 https://padlet.com/bripinkston20171/98h1uyhil87mfckp/wish/822625232 These plans provide some flexibility to the HMO model and are sometimes referred to as open-ended plans. Under a POS plan, an enrollee can use services that are out of plan, in exchange for deductibles and coinsurance payments. The plan tries to address some of the shortcomings of the pure HMO approach (Buchbinder pg. 199).]]> 2020-10-12 18:55:34 UTC https://padlet.com/bripinkston20171/98h1uyhil87mfckp/wish/822625232 Private Health Insurance amstransky16 https://padlet.com/bripinkston20171/98h1uyhil87mfckp/wish/822628973 Definition: payments made by individuals and/or their employers for health insurance premiums, which in turn cover the costs of payments made by various health plans.

Types: Indemnity, PPO, HMO, POS (Buchbinder pg. 197).]]> 2020-10-12 18:56:58 UTC https://padlet.com/bripinkston20171/98h1uyhil87mfckp/wish/822628973 Affect on HCP amstransky16 https://padlet.com/bripinkston20171/98h1uyhil87mfckp/wish/822656541 According to table 9-3 on page 197, private insurances can be hard to manage for healthcare providers. Most types of private insurances include a lot of paperwork and come with high administrative costs. Along with the difficult management, this insurance is also known to have quality issues (Buchbinder pg. 197)]]> 2020-10-12 19:07:46 UTC https://padlet.com/bripinkston20171/98h1uyhil87mfckp/wish/822656541 Preferred Provider Organization ryantarver31 https://padlet.com/bripinkston20171/98h1uyhil87mfckp/wish/822664410 PPO, which stands for Preferred Provider Organization, is defined as a type of managed care health insurance plan that provides maximum benefits if you visit an in-network physician or provider, but still provides some coverage for out-of-network providers  (Medical Mutual, 2020).  Additionally, you can usually visit any provider without a referral from your primary physician.  (Medical Mutual, 2020) 

Managed care plans attempt to reduce the cost of medical care while maintaining quality of care.  PPO plans were created to gain some of the cost-saving features of an HMO (like having a network of providers) while giving members more flexibility than with a typical HMO  (Medical Mutual, 2020). This mix of lower costs and greater flexibility makes PPO plans extremely popular.
 (Medical Mutual, 2020) ]]> 2020-10-12 19:11:00 UTC https://padlet.com/bripinkston20171/98h1uyhil87mfckp/wish/822664410 References amstransky16 https://padlet.com/bripinkston20171/98h1uyhil87mfckp/wish/822672662
  • Buchbinder, S. B. (n.d.). Introduction to Healthcare Management (4th ed.). Jones & Bartlett Learning. doi:9781284205312.
  • Cigna. (2020). What is point of service (POS) insurance? | Cigna. Cigna Official Site | Global Health Service Company. https://www.cigna.com/individuals-families/understanding-insurance/pos-health-insurance
  • Hayes, A. (2020, July 5). Health Maintenance Organization (HMO). Investopedia. https://www.investopedia.com/terms/h/hmo.asp#:~:text=A%20health%20maintenance%20organization%20(HMO)%20is%20a%20network%20or%20organization,under%20contract%20to%20the%20HMO
  • Medical Mutual. (2020). What is a PPO? Understanding PPO Health Plans. https://www.medmutual.com/For-Individuals-and-Families/Health-Insurance-Education/Health-Insurance-Basics/Types-Health-Insurance/PPO-Health-Insurance-Plans.aspx#:~:text=PPO%2C%20which%20stands%20for%20Preferred,out%2Dof%2Dnetwork%20providers
    • ]]>     2020-10-12 19:14:22 UTC https://padlet.com/bripinkston20171/98h1uyhil87mfckp/wish/822672662     Table 9-3 amstransky16 https://padlet.com/bripinkston20171/98h1uyhil87mfckp/wish/822762673 2020-10-12 19:53:24 UTC https://padlet.com/bripinkston20171/98h1uyhil87mfckp/wish/822762673 Managed Care Plans bripinkston20171 https://padlet.com/bripinkston20171/98h1uyhil87mfckp/wish/838910618
    Unlike indemnity plans, these health plans seek to manage cost, quality, and access to health services through control mechanisms on both patients and providers. Some of these systems attempt to include both the financing and provision of health care into one organization. The primary types include HMOs, PPOs, and POS plans (Buchbinder pg. 199).

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