Insurance Expenses Discussion

Insurance Expenses Discussion essay assignment

Third-party payers pay for covered insurance expenses for an insurance recipient or a designated beneficiary. This includes payment for medical expenses owed to a health care provider or to the insured for reimbursement when the insured incurs covered out-of-pocket expenses.

Third-party payer organizations can be either private or public entities, such as a health insurance company or Medicare or Medicaid agency.

Many types of health insurance options are available to patients either by employer-provided plans or commercial plans. Currently, the largest health payer is United Health Group, which provides networks for care and is a commercial and employer-based insurance company. Public options include Medicare for adults over 65, TRICARE established by the Department of Defense, and Medicaid, which is a joint plan funded by states and the federal government for those with low income.

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Third-party payers often don’t pay 100% of a patient’s bill. Deductibles are the portion of the bill the patient pays before the insurance company becomes responsible. Many of today’s high-deductible plans may require the insured to pay up to $5,000 out of pocket before the insurance company pays.

Here are a few more options available:

Managed care, also called Health Maintenance Organizations (HMOs) combines healthcare providers with insurance companies to keep costs down.
Preferred Provider Organizations (PPOs) are those networks that include healthcare providers and insurance that doesn’t require the patient to use a certain provider, but the patient incurs more expense if they go outside the network.
Health insurance exchanges offer an opportunity to purchase insurance that is not employer-provided or if the patient is self-employed. There are core elements to increase wellness and preventative healthcare.
High-deductible health plans provide a big incentive to stay healthy for those that need less expensive insurance

2.Hello Class,

This is the last week! and for this week we are to compare and contrast major third party payers for health insurances. So third-party payers are public or commercial organizations that pay or cover health-care costs for beneficiaries while they are patients. This includes compensation for eligible out-of-pocket medical expenses payable to a health care provider or payment for medical expenses owed to the insured. As a military member I am covered through Tricare Prime which means all my expenses are payed 100% within a government network. My closest friend who has Blue Cross Blue Shield, would fall under a commercial health insurance program which is most common across the nation. Monthly premiums are given and and depending on the hospitalization or visit the member either has their premium pay for it at a fraction of the cost or pay a copay to pay for it entirely/fraction. It varies base on the monthly payment to which premium you are covered in.

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