As my MBA concentration is in General Business and Finance the most relatable to my…
As a resolution analyst at UnitedHealthcare (UHC), over ninety percent of my decisions are based on evidence provided by providers’ and members’ health policy contract and UHC reimbursement policies. The health policy contract provides payment regulations on how to correctly make a decision of either a claim is to be denied, paid or if additional steps are required. In a case where a member is asserting that an out-of-network provider should be reimbursed in-network based on their research involves investigating beyond the member’s contract and UHC reimbursement policies to justify an overturn. If the member provides proofs such as a copy of the participating provider listing on UHC's website or the provider proper Tax ID to support their…
The Allstate Corporation was started in 1931 as part of Sears, Roebuck and Company. In 1993, the Corporation splinted from the organization, and now it is ranked third-largest personal lines insurer. This insurance company is well established to the US people through its slogan name, "You're In Good Hands." It faces stiff competition from the State Farm Company, which is ranked above it in terms of annual revenue returns. However, it is the largest publicly held corporation and the best insurance company, which makes it more stable in the financial and insurance industry (Allstate Insurance Company). It has a market capitalization of $35.2 million with $108.5 billion in its total assets. On the other hand, State Form Company, which is the key competitor, have $13.08 million market capitalization.…
1: Complete a one page position paper (your opinion) about current health and human services reimbursement.…
integration. John D. Rockefeller perfected horizontal integration and was very successful with his involvement with oil. J. Pierpont Morgan was considered the Bankers’ Banker and his interlocking directorates with the United States Steel. All three circumvent competition and come from lower middle class. What is impressive about them is that they had little to no education and did not indulge in extravagances.…
Most immigrants are viewed as invaders of the United States and immigration is not a well understood topic. Barbara Kingsolver’s novel, The Bean Trees, shows multiple perspectives of people who experience i mmigration. In the novel, immigration was a topic that was initially unknown by the protagonist, Taylor. As the story progresses, Taylor meets multiple people that are involved in the many facets of issues facing illegal immigrants. This pulls Taylor into another side of immigration and as readers follow, it makes them question if it is better to follow the law or do what is right . The Bean Trees suggests there is more than one side of the story to immigration and immigrants. Through the use of elements of fiction, Kingsolver suggests some immigration policies are unfair, immigration can cause people to live in fear and become socially reclusive, and that stereotypes are not always accurate.…
From these chapter I have gain the knowledge of know, the delivery of health traditionally evolved around the individual relationship between the provider and patient/consumer. The payment was either provided by a health insurance company or paid out of pocket by the consumer. This fee-for-service system or indemnity plan increased the cost of healthcare because there were no controls on how much to charge for the providers service. As healthcare costs continued to spiral out of control throughout the decades, more experiments with contract practice and prepaid service occurred randomly across the U.S. healthcare system (Shi & Singh, 2008)…
In 2013 the states were given the opportunity to expand on Medicaid under the affordable care act. With this expansion the government would pay a 100 percent for the first three years and reduce down to 90 percent over ten years. Many of the southern states chose not to expand and went on to search for private insurance companies to help cover the cost they would be losing in the future years. These states include Texas, Florida, Georgia, Missouri, North Carolina, Virginia, Louisiana, Oklahoma, and Wisconsin. Two state that are undecided is Tennessee and Indiana. Texas was all for making sure people were insured in health and wellness but they had their own idea of covering them.…
This assignment is to discuss the major provisions of the Massachusetts health care reform laws of 2006. In April there were about fifty eight which were put in to the law. By putting these into effect they made a stand for the health care reform. It was then that Massachusetts could provide affordable health insurance for its residents. When the legislation met they came to a compromise in which it was reached by the then Governor Mitt Romney who was a republican, and was also joined by Robert Travaglini and Salvatore Dimasi. It was discussed and believed that everyone in the state should have health insurance, but they were in hopes that it would be affordable. They finally decided to make insurance affordable as long as they could use…
The individual mandate in health reform is quite controversial. Discuss one policy argument supporting the mandate and one policy argument opposing the mandate=============.…
For the past several years, the health care and insurance industries in America have been undergoing significant reform in order to rein in the high cost of delivering health care services. Managed care has become a cornerstone of this process (Strickland, 1995). The case management industry (with its focus on cost containment, managed competition, and quality care) is playing an increasingly important role in the managed care environment (Owens, 1996). According to Mullahy (1995a), the number of case managers has risen astronomically in recent years. These individuals come from diverse professional backgrounds and practice settings that include nursing, rehabilitation counseling, and social work.…
Health care is always going to be an important issue, especially when much of the population does not have coverage for one reason or another. A series of surveys were conducted in 2010 in Central Texas by the Central Texas Sustainability Project (CTSIP) to find out who had health coverage. They also asked follow up questions to those who do not have health care coverage to get the reasons why and to determine trends in their data.…
Throughout American history congress has had to resolve problems that arose nation wide. Pell Grants, created in 1972, and the Affordable Care Act of 2010 are just two of the legislations created to solve some of the United States economic problems. Although these two solutions were both initiated to boost America’s economy and to support low income families, the reason for the intervention of the government and their results differ.…
Imagine paying $500, $600, $700, or $1,000 monthly for health care insurance only to realize these payments were for naught. The health care insurance provider that received these monthly installments has decided whatever is ailing you will not be covered due to a pre-existing medical condition. What if you couldn’t have the luxury of health care insurance at all due to the basis the health care insurance provider has concluded you have a pre-existing medical condition? These are the dilemmas facing millions of Americans today in the current health care system. America’s health insurance companies exist to make a profit and not for the general well being of the persons they insure. To achieve a profit the health insurance companies must deny coverage claims when Americans need coverage the most or not cover these individuals in the first place. This is a problem that the United States is addressing, or trying to address, in heated debate on Capitol Hill. Many of our Republican politicians want to continue with the status quo of the health care system while Democrats seek to eliminate pre-existing conditions altogether. The American public has come to recognize there has to be a major overhaul of the current health care system starting with pre-existing conditions.…
US health care expenditures have been rising quickly over the past few years; it has risen more than the national financial system. Nonetheless a number of citizens in the US still lack appropriate health care. If the truth be told, health care expenditures are going to continue to increase; in addition numerous individuals will possibly have to make difficult choices pertaining to their health care. Our health system has grave problems that require reform, through reforming, there is optimism that there will be an increase in affordable health care and high-quality of care for America. Medicaid, Medicare and private sector insurances are all going through trials and tribulations because of spending. Obama Cares purpose is to put consumers back in charge of their health care and aid in driving down the cost of spending in health care. The reform will also strive to put forward a delivery system that operates better for all involved thereby decreasing organizational burdens and assisting in the collaboration towards improved care. If the reform is successful, it will lead to measureable improvements in care outcomes, and in the health of the American general public overall.…