Question

Scenario: A patient is confused about how to make payments for a recent visit to urgent care and hospital stay. Her insurance provider 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 help desk representative why they can't just make the payments for her. She is told about the various payment types and payers in the healthcare industry and how the market influences the integrated delivery systems in the industry.

After reading the scenario, answer the following (75-100 words each answer) in a separate document:

3. How might the insurance provider explain the payment system they utilize for their clients? Explain if this method is effective or not for their clients.

Answer 1

The insurance provider may explain the payment system they use for their clients as follows,

1. In the practical world, we receive a lot of claims daily settling each claim is a big task for us, so we are not able to make the payments directly to the hospital
2. Instead we are issuing checks to the clients.
3. This is to ensure proper controls as to delivering right amount to the right person, and avoidance of any delays for the clients to get the payments processed.
4. It also saves a lot of time to the client and even for us.

Effectiveness of such a method,

1. Using this type of method of making payments is effective for client in one way and ineffective in another way,
2. In one way the payments will get processed very fast,
3. And in another way, it is clerical for the clients to do all these tasks collection of check from insurance company and issuing it to the hospital.