When making a decision on the kind of managed care scheme to purchase, it is important to pay
Managed Care
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Introduction
When making a decision on the kind of managed care scheme to purchase, it is important to pay close attention of various items. In the process of selecting one insurance program over the other, individuals are advised to be aware of the provisions of such plans. Therefore, individuals intending to purchase a managed care program should engage in the process of evaluation, which involves asking question, studying the plan, reading and good luck (Patient Advocate Foundation, 2017). In this regard, there are nine essential criteria, which can be used when evaluating this plan. Some of these include benefit offered, benefits v. cost, satisfaction of customers among others. The paper will analyse the nine criteria used in appraisal of managed health care.
Firstly, it is essential to consider a managed care that provides an all-inclusive benefit package such as preventive health care services and treatment plans for the management of chronic diseases. In addition, it should offer emergency care services. In case such services are crucial in your life, ensure that you get satisfactory responses on the treatment benefit offered (Patient Advocate Foundation, 2017). Secondly, there is a wide range of managed care programs depending on the cost involved in provision of services. Some of the least costly plans are more likely to provide limited services. Managed care requires two types of cost, which are out-of-pocket expenses and premium. Out-of-pocket refers to the amount of money a person is required to pay after insurance cover the cost of health services. Some of the expenses of out-of-pocket include co-insurance, deductibles and co-payment (Patient Advocate Foundation, 2017). Therefore, it is important to ask on the kind of expenses that an individual will be required to pay.
Thirdly, an individual must select the services to be conducted by the primary care physician (PCP). In this regard, it is important to acquire the Provider Membership Directory, which may be described as an enrolment of active physicians. Preferably, select a plan in which your private doctor is a member. Similarly, choose a doctor whose name you can enrol with the insurance organization. In addition, ensure that you get important information about a particular doctor before selecting him/her. Fourthly, when appraising managed care it is essential to understand the type of benefits of prescription drug that the plan provides. For instance, some program provides a ‘generic only system, which means the insurance would only insure costs related to generic drugs (Patient Advocate Foundation, 2017). Additionally, patients are required to pay the complete cost of drugs if their selected plan does not have generic alternatives.
Fifthly, individuals are advised to check the network of health care providers in their geographical region. The Provider Membership Directory offers such information. In case a person stays in a particular community but works in a different one, it is beneficial to inquire how the routine health care can be obtained in either place. Sixth, a person should pay close attention on the commitment of the program to quality of health services and care (Patient Advocate Foundation, 2017). In this regard, an individual must consider the measures put in place to guarantee the satisfaction and quality of health care. Therefore, a buyer should check whether the National Committee for Quality Assurance recognizes managed care. The seventh criteria involve consideration of customer satisfaction. An individual should ensure that measures to facilitate satisfaction of customers such as HMO report cards, and accreditation.
Moreover, eighth criteria reflect on issues such as exclusions, maximums or limitations. Lifetime Cap describes the maximum amount of money and benefits that a managed care program can provide in his/her lifespan. Some health interventions require lengthy hospital stays and expensive support, which deplete the Lifetime Cap. After depletion of Lifetime Cap, an individual is required to pay for other expenses (Patient Advocate Foundation, 2017). Therefore, a buyer should review the Lifetime Cap prior to acquiring a managed care. Finally, the Consolidated Omnibus Budget Reconciliation Act (COBRA) provides on how a person can change his coverage of health care via his/her boss to a personal plan. Such occurs in case a person is sacked or cannot continue with the job. COBRA also provides a wide range of limitations, benefits and rights of the buyer of managed care. Therefore, it is vital to know the rights and benefits offered under this act prior to purchasing any managed care program.
Conclusion
Based on the evaluation, my managed health care insurance meets my needs since it offers to sustain the satisfaction of customers and guarantees my rights and benefits pursuant to COBRA as well as quality assurance. In addition, it describes my Lifetime Cap hence I am able to know the maximum amount of benefits I can receive from the insurance. It also ensures that my doctor is listed in the Provider Membership Directory as well as benefits to be acquired under prescription drugs. Finally, it describes comprehensively on how to pay my premiums.
References
Patient Advocate Foundation,. (2017). The Managed Care Answer Guide. Your Health Policy Folder. Retrieved 30 January 2017, from http://www.rwjuh.edu/uploads/public/documents/main/mc_answer-guide.pdf