Discuss the basic elements of healthcare insurance provider contracts from both a provider and a payer...
Discuss the basic elements of healthcare insurance provider contracts from both a provider and a payer perspective. Is there a significant impact for one party over the other and why or why not?
Homework Answers
There are five key elements of healthcare insurance provider contracts from both a provider and a payer perspective.
1. Provider network
This includes all the health care facilities that contracts with to provide services to its customer.
2. Drug formulary
It is a list of drugs that covers your plan. If any drug other than from this list may not be included in the policy benefit.
3. Premium
It is the amount you pay to the insurer.
4. Deductibles
It includes services such as preventive care, yearly wellness visit, immunizations etc.
5. Plan benefits
Plan may include broader coverage. It includes a list of health care services that helps to understand your health insurance options.
There is no any significant impact of one party over the other.it helps to manage cost for both the insurer and the beneficiary.
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