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Insurance Methods And Pay Expectations

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Category: Social Issues

Autor: Debra50G 07 August 2013

Words: 956 | Pages: 4


There are so many various insurance companies with different methods of payment and expectation of payment. There is government insurance, Medicare and Medicaid, Commercial Insurances through employers, liability insurances and self pays. All have their own way of paying out. Some require deductibles and co-pays while others don't.

Insurance Methods and Pay Expectations

There are so many insurance companies and various ways of payments and even requirements, such as a deductable has to be met, or a co pay must be paid at the time of service. This paper deals with the various methods of insurances and payment expectations.

Government Insurance:

The two government insurances are Medicare and Medicaid. The Medicare insurance program is government insurance for those 65 years of age and over, and the disabled. This program is purposed to reduce health care costs. It usually only covers partial expenses accrued; not all of the expenses.

The purpose of the Medicaid government insurance is to provide the low income and children with their health care finances. They make the payment directly to the facility, not to the patient. Doctor visits, hospital and prescription drugs are covered under Medicaid, but not hearing, dental or vision is covered, unless under certain policies it is an emergency (HHS Government n.d.)

Under both Medicare and Medicaid, payment expectations for the hospital, is they reimburse the hospital after the patient is discharged.

Commercial Insurance:

Commercial insurance is where employees buy insurance from the employee's group policy. Companies such as Blue Cross and Blue Shield or Aetna and State Farm all sell commercial insurance. An employer may purchase a group policy for his employees. This is the cheapest way for an individual to buy healthcare for him and or his family. Today, because there has been an increase in the group policy rates, there are a lot of employees who are covered, yet they can't cover the premiums to cover their family members. The pay expectation is different for most the insurance companies. Some want to reimburse the insured, after insured pays the bills in full. Others will cover after deductibles are met, and they are fairly quick to pay the bill after. Another way they pay is direct to the facility after care, treatment and or stay is completed.

Liability Insurance:

Liability insurance helps protect an individual from malpractice, injury and negligence. Liability insurance will also cover legal costs and payouts if guilty of one of the above. There are monthly payments made to the insurance companies, known as premiums. After all treatment has been rendered and patient is discharge then insurance pays. Most times there are co-payments that must be made at the time of service.

A Self Pay

A self-pay patient pays for services in cash or credit card. They usually don't have insurance because they cannot afford it or the employer does not offer it. They can pay in full cash at the time of services or pay something down and make arrangements to make small monthly payments till the bill is paid (MGMA, 2009).

Insurances are all different in how they work. Some require co-pays, deductibles, and premiums paid per month. Other such as government insurances, may or may not require a co-payment but that is entirely decided on by the facility the patient visits. However, they pay, what they have in common is to assist in healthcare costs. Some self-pay patients may be offered a discount for paying off their bill in full. For the collection of payment the insurance sends the insured a bill, and sends it every month till the bill is paid. The self pay person will also receive a bill from the facility every month until their agreed amount is paid in full.

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