Case Scenario

A patient is confused about how to make payments for a recent visit to urgent care and hospital stay. Her employer-based insurance provider’s website allows her to use her HSA account to make a payment online. She uses her HSA debit card to make the payment, but her insurance provider sends her a check instead of sending it to the Tri-City HealthCare Agency. After contacting her insurance help desk via the website, she is told to send the check to Tri-City HealthCare Agency herself. The patient asks the insurance provider’s help desk representative why they cannot just make the payments for her. She is told about the various payment types and payers in the health care industry and how the market influences the integrated delivery systems in the industry.

Case Questions

  1. Describe the payer systems mentioned in the case study.
  2. Explain how the market forces have influenced the need for integrated delivery systems.
  3. How might the insurance provider explain the payment system it utilizes for its clients? Explain if this method is effective or not for the insurance provider’s clients.
  4. What has been the most significant legal and regulatory effect on managed care organizations?
  5. How would this case study have differed if the patient was using public or social insurance?

Explanation & Answer length: 5 Questions 200 Words Each

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