Question

You are the nurse manager of a 15-bed intensive care unit (ICU) and you have 50 staff on your unit.  The ICU staff is focused on patient-centered care and treats patients equally, regardless of insurance type. Occasionally the staff has insurance-related questions that arise from the patients and families or are based on personal inquiries.

1. It is open benefit enrollment period at your hospital.  The ICU staff received an email reminder to enroll in the health care benefits plan for next year. Your company is offering the following plans: Health Maintenance organization (HMO), preferred provider organization (PPO), and a high-deductible plan. The nursing staff has questions related to the various plan types and asks you to describe the differences in the plans. How will you describe the plans?

2. Your employee was transferring a patient from the stretcher to the bed when she felt pain in her lower back. She notified you about this plan immediately. You instruct her to go to the emergency department for treatment and notify the workers’ compensation department. What is workers’ compensation? Is the employee responsible to pay for this type of insurance?

3. How do Providers and Hospitals get paid by Private payers, public payers, and the uninsured? What is the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)?

Answer 1

1. Describing to the staff about the insurance plans

Hello Staff, Good Morning.

This meeting was held to discuss about the health insurance plans we provide and the differences between each of them.

We offer three insurance plans one is HMO that is "Health Maintenance Organization" ,second one is PPO that is " Preferred Provider Organization and the third one is " High Deductable Plan.HMO is a US Health insurance plan which provides services through a network of physicians who are under contract with HMO.They pay monthly or annually.PPO is the Health Care plan where they lay a contract with hospitals and people who prefer those hospitals can pay less amount for the care provided.HMOs asks to select a primary care physician with in the medical facilities and where as PPOs had no restriction in selecting the physician.There is no need to pay more money out of pockets for HMO,where as for PPO spending money from pocket is more.On other hand High Deductible Health Care plans provide low monthly premiums and high deductibles but the patient will covered in to the plan through out the calendar year.

2. What is workers compensation? Is the employee responsible to pay for this type of insurance?

Workers compensation is an insurance plan. If any injury happens during the hospital treatment , the wages will be paid for the negligence of the employee by the employer or the Health Insurance company. But employee will not pay any compensation.

3.How do providers and hospitals get paid ? What is Medicare Access and CHIP Reauthorization Act 2015.

Government or public programmes pay very less amount than actual care of cost to the hospitals making the hospitals to loose more.Many uninsured people pay very little amount and some times they leave hospitals with out paying. On other hand private insurers pay 30 percent of all the amount.

Medicare Access deals with the revised payment system for doctors by increasing the funds and CHIP Act deals with the extension of insurance to the children.CHIP refers to Child Health Insurance Plan.