Introduction
We always say I am healthy but what does being healthy actually means? The term healthy is defined different by different persons. Generally, being healthy means being void of illness or any form of injury. But is this actually true? Can anyone be really free from any form of illness of injury? The answer to this question is no. People are prone to illness or injury but after falling sick what? Then comes the step of visiting the provider. Number of visits (to physician offices, hospital outpatient and emergency departments) is 1.2 billion alone in the US [1]. Also, such visits turns out to be very costly. The only factor that makes it affordable is the health insurance
What is health insurance
According to the Health Insurance Association of America, health insurance is defined as "Coverage that provides for the payments of benefits as a result of sickness or injury. Includes insurance for losses from accident, medical expense, disability, or accidental death and dismemberment" [2]. Health insurance processing is one of the few complex processes that take place after visiting the provider. Applying for claims is carried out after pre authorization. Pre authorization is an integral part of utilization management.
What is utilization management
Utilization management (UM) is the process by which a health care system and services and facilities can be evaluated to check if it is appropriate and if it is established as per the guidelines set by the health benefit plans. Utilization management describes proactive procedures, discharge planning, concurrent planning, precertification and clinical case appeals. UM also covers concurrent clinical review and appeals introduced by the provider, payer or patient.
Utilization m...
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...lanation of Benefit (EOB) is created along with benefit check which is mailed to the patient and the physician respectively.
Conclusion
Reference:
[1] Selected patient and provider characteristics for ambulatory care visits to physician offices and hospital outpatient and emergency departments: United States, 2009-2010
[2] How Private Insurance Works: A Primer by Gary Caxton, Institution for Health Care Research and Policy, Georgetown University, on behalf of the Henry J. Kaiser Family Foundation.
[3] http://chiroeco.com/chiro-blog/medical-clearinghouse/2009/04/07/paper-claims-vs-electronic-claims/
[4] http://www.ihealthbeat.org/picture-of-health/2013/what-percentage-of-health-insurance-claims-were-filed-by-paper-or-electronic-processes
[5] http://www.wisegeek.org/what-is-claims-adjudication.htm
[6] http://www.staysmartstayhealthy.com/health_insurance_deductibles
The Crowded Clinic Case Study (Colorado State University - Global, n.d.) discusses the issues of practice management as they apply to access to care. Access to care may be as inconvenient as lengthy patient wait times to issues far more serious that may have a profound effect on the health and well-being of a single patient or an entire cohort.
Starfield, B, Cassady, C, Nanda, J, Forrest, C, & Berk, R. (1998). Consumer experiences and provider perceptions of the quality of primary care: implications for managed care. The Journal of Family Practice, 46(3), 216-226.
Three areas that define the provisions of comprehensive health care services and are commonly used for utilization monitoring and control are gatekeeping, case management, and utilization review (UR). Gatekeeping is used by HMOs where each member designates a primary care provider (PCP) that is responsible for coordinating all care services needed for the enrollee in a managed care plan. Case management involves an experienced health care professional with knowledge of available health care resources. `Case management services are designed to identify spec...
Reese, Philip. Public Agenda Foundation. The Health Care Crisis: Containing Costs, Expanding Coverage. New York: McGraw, 2002.
Insurance is a factor in the health of Americans. Most companies are required to offer insur...
Health is described as physical and mental well-being and freedom from disease, pain or defect. However, such descriptions only superficially define the actual meaning of health. There may be many occasions when individuals are not necessarily ill or in pain but may be overweight, stressed or emotionally unstable. Health is a quality of life involving dynamic interaction and interdependence among the individual’s physical state, their mental and emotional reactions, and the social context in which the individual exists. There are many factors that influence your health, but three major components contribute to general well-being: Self-awareness, a balanced diet and, regular physical activity.
In this essay I am going to investigate whether health is easily defined as the absence of disease or physical injury. According to Health psychology (2009) ‘World Health Organisation defined health as a complete state of physical, mental and social well-being and not merely the absence of disease or infirmity’. In order to achieve good physical a nutrition diet is needed, healthy BMI, rest and adequate physical exercise is needed.
Health insurance provides benefits for sickness, injury, surgery, and prescription medication. There are a variety of plans with different
In 1983, the Medicare prospective payment program was implemented, which allowed hospitals to be reimbursed a set payment based on the patient’s diagnosis, or Diagnosis Related Groups (DRG), regardless of what treatment was provided or how long the patient was hospitalized (Jacob & Cherry, 2007).... ... middle of paper ... ... Case Management Related to Other Nursing Care Delivery Models.
...ank Research (2010). Coverage vs. Cost. The US health care reform in perspective. Retrieved from http://www.dbresearch.com
Nordqvist , Christian. "What Is Health? What Does Good Health Mean?." Medical News Today 21 May 2009: n. pag. Web. 1 Apr 2011. .
What does it mean to be healthy? Health is a state of complete physical , mental, and social well-being and not merely the absence of disease, illness or infirmity. It is important to distinguish between disease and health. Disease is the prognosis of a particular disorder with a specific cause and characteristic symptoms. On the other hand, illness is the existence of disease
This also requires the person to be socially and economically productive in order to be seen as healthy. According to Mildred Blaxter (1990), there are different ways of defining health. Furthermore, disease can be seen as the presence of an abnormality in part of the body or where there is a harmful physical change in the body such as broken bones. So, illness is the physical state of disease, that is to say, the symptoms that a person feels because of the disease. However, there is some limitation of these definitions which is not merely an absence of disease but a state of physical, mental, spiritual and social wellbeing.
What makes a person healthy? Surely, it is more than exercising and a proper diet. As a ten year-old girl, being healthy had one meaning to me; to eat all my vegetables and to be physically fit. I have chosen healthcare as a career because health does not only focus on the physical aspects of wellness, but it applies to all areas of wellness, such as, intellectual, social, spiritual, financial, occupational, environmental and emotional wellness.
healthy is a major component in ones’ overall wellbeing, more so mentally, but being healthy