Reflection Paper On Health Insurance

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Report of What I learned Throughout Chapters 1-3 As I started my Health Insurance class my belief was that this class will be pretty easy as I am familiar with much of the medical field. Personally having multiple illness’s and having three special needs children, personally I have learned so much within the medical field. However, as I began reading Chapters 1-3 in my Understanding Health Insurance book, the realization hit that I was not as knowledgeable as I thought I was. Therefore, I am eager and excited to learn new things in the medical field. Health insurance specialists has become a very challenging career, however, provides the opportunity for advancement. Possessing the knowledge and understanding with processing claims and billing …show more content…

Managed health care actually combines health care delivery with the financing of services provided. This was intended to replace conventional fee-for service plans with much more affordable quality of care to the health consumers as well as the providers who was in agreement with the restrictions. However, managed care is becoming challenged due to the growth of consumer-directed health plans, which defines employer continuations and asking employees to be more responsible within their health care decisions and cost-sharing. The Americans health care system has been changing the way their health care services are organized and delivered. As seen by the movement from traditional fee-for-service systems to managed care networks. Ranging from structured staff model HMOs to the lesser structured preferred provider organizations (PPO). Statistics show that 60 million Americans are enrolled with some type of managed care program within the response to regulatory initiatives which affect health care cost and quality. Managed care organizations are responsible for the health of their enrollees, which can be administered by a physician’s group, health system, or even a hospital. Much of the managed care financing is through a method called capitation, and the enrollees are assigned to a select primary care provider, which serves as a gatekeeper.

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