HSM 543 Week 6 You Decide

Topics: Insurance, Health insurance, Risk Pages: 3 (880 words) Published: February 23, 2014

You Decide-Back to the Drawing Board
Student Name
HSM 543
February 16, 2014

As the CFO of Community Memorial Hospital, I have a major problem on my hands that could lead the hospital in a financial bid. Bill Jacobs, the Human Resource Director of Commercial Intertech (CI) which is the largest employer in the community, has signed a contract MegaPlan Health. MegaPlan is a known insurance company that gives hospitals a very hard time especially when it comes to discounts and fighting claims the hospitals make. Since all of our employees and their families will be using MegaPlan Insurance and Community Memorial is not on their Preferred Provider Network (PPN), I need to figure out if we should work with or without MegaPlan. If so, I will have to decide to sign this contract that they sent over that includes a 35% discount from charges and service pre-authorization requirements or write a contract of my mine with all of our terms and conditions and see if they agree to it. Regardless of the decision I make, there will be major risk involved working with MegaPlan Insurance.

After taking inconsideration everything scenario and thinking about everyone’s opinion (Chief of Staff, CEO, Business Office Manager and CNO), I have decided to take the CEO advise and make my own counterproposal and see what MegaPlan will say about it. I chose this option because I felt that MegaPlan is trying to get too much out of us especially when it comes to the 35% discount because I know from experience that the hospital loses money whenever the discount from charges exceeds 20%. And the fact that MegaPlan wants us to pre-authorization requirements for services that need to be provider is just providing us with more work when we are already putting a lot of responsibility on our employees. According to healthcare.gov, pre-authorization requirements is when the health insurer or plan makes a decision whether a health care service, treatment plan, prescription...
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