Indemnity Versus Managed Care

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Asia Armstrong HCR 220 Professor: Holt Due Date: 10/2/2013 Healthcare is needed daily, too many individuals all over the world. Individuals over the age of 65 are in need of healthcare. This is a reason why there is a rise in healthcare spending. Healthcare is very vital for those who deal with chronic diseases such as diabetes, hypertension as well as osteoporosis. As a result of the rise in healthcare spending, the economy is growing rapidly thus, having elevated healthcare costs. Furthermore, in healthcare there are two types of plans, that all insurance plans are based on. These two plans are Indemnity, and Managed Care. An Indemnity plan is a plan that provides security against loss. With this plan, the patient is able to have the flexibility of choosing their own physician. A claim form is usually sent to the insurance company from the physician with the patient’s information, along with any services provided by the doctor. However, Managed Care is different. This plan is more restricted in regard to physicians and services that are available. Because of having this type of plan, there are low premiums, deductibles, in addition to other charges. Managed Care uses organizations known as (MCOs).…show more content…
According to Valerius, J., Bayes, N., Newby, C., & Blochowiak, A. (2014) (Pg.9), the four conditions of payments are as follows: 1. “The medical charge must be for medically necessary services and covered by the insured’s health plan”. 2. “The insured’s payment of the premium, must be up- to – date-, unless the premium is current. If the insured does not abide by the policy, then the insured will not be eligible for benefits. Nor will the insurance company make a payment.” 3. “A deductible must be paid before the benefits begin”. 4. “The insured may also have to pay a portion of charges after the deductible is paid, known as a

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