Reimbursement Methodologies

Topics: Health insurance, Preferred provider organization, Health economics Pages: 2 (517 words) Published: February 17, 2009
As the Human Resource Director for XYZ Company, I have been doing some research on HMO and PPO group health plans for my employees. I have spent approximately three to four days researching material on both HMO and PPO group insurance for the employees. In my studies, I decided that the HMO would be the best group insurance for the number of company employees. With the number of employees that work for the company, the HNE Health Max Option 3 would be the right insurance plan. There is usually just a co-payment for every visit, including the hospital with HNE Health Max Option 3. In addition, with the HNE health Max Option 3 health plan, there is not an individual or family deductible to meet. The co-payment ranges from $0 to $20 per visit, $50 for the emergency room care, $25 for ambulance and chair van services and day rehabilitation services. However, with durable medical equipment, including ostomy supplies and prosthetic limbs the requirement is 20% co-payment. However, with HNE PPO Complete National there is a co-payment maximum per calendar year of $1,000 per individual and $2,000 per family. In addition, HNE PPO Complete National plan there is usually and require deductible to meet and a higher co-payment. The co-payments range from $0 to $500 and some service require a 20% co-payment. Even with restriction on seeing a primary care physians, I feel the HNE health Max Option 3 plan would be less money out of the pocket expense for the employees. How I came to my conclusion is by visiting serial web sites by using Google search engine, and the Student Library, study guides, health medicine and nutrition, and health plans. I went to AHIP, used the search engine, and read the article on Small Group Health Insurance 2006. In this article, I read the figures on the cost of PPO plans with the number of employees. With Google search engine, I entered PPO and HMO insurance. I read serial articles on the difference between HMO vs. PPO...
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