Andrew Rider of Michigan Insurance Company referred this file for medical case management. Instructions were given to meet with John Pero and assist with coordination of appropriate and related medical care, and identify needs to facilitate recovery.…
Edgewood Lake Hospital (ELH) which opened in 1945, is a 30-bed, independent, not-for-profit hospital located in rural northern California. It provides inpatient and outpatient services to the close-knit community that resides within the forested and lakeside town the facility is nestled in. Although it is known for its great track record for quality and is held in high regard by the surrounding community, it has steadily experienced financial losses from 2006 through 2009. These losses can be attributed to factors both internal and external to the facility itself.…
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…
Grady Memorial Hospital frequently referred to as Grady Hospital or simply Grady, is the largest hospital in the state of Georgia and is the public hospital for the city of Atlanta. Historical segregation of its hospital units meant that it was also called "The Gradys," a name that still surfaces among elderly Atlanta residents, especially African Americans. Grady is a Level I trauma center. Trauma is any life-threatening occurrence, either accidental or intentional that causes injuries. The leading causes of trauma are motor vehicle accidents, falls, and assaults. Located downtown near the campus of Georgia State University, Grady is considered to be one of the premier public hospitals in the Southern United States. Grady Hospital is named for Henry W. Grady, an Atlanta Constitution journalist and later owner who became a major force in Georgia politics, and advocated for a public city hospital. Grady is now the flagship of the Grady Health System (Grady, 2009). Marketing plays an important role at Grady Memorial Hospital. This paper will explain product, price, place and promotion of this hospital as well as examine the relationship between the organizations marketing and partnerships. It will also touch on why…
Belmont Lodge Health Care Center is a nursing home located in Pueblo, Colorado. Belmont Lodge Health Care Center is a 120-bed facility. Belmont Lodge Health Care Center provides its services to long-term and short-term residents. Belmont Lodge Health Care Center provides assisted living and resident care facility to elderly residents.…
A patient comes in to the doctor’s office and checks in. At this time, the front desk asks if they have insurance…
The Center for Disease Control recommends the public to get an annual flu shot. If each person on campus were to get vaccinated they would be protected and prevent those who are more vulnerable to catching the virus. According to the Center for Disease Control, there is a 71% reduction in flu-related hospitalizations among adults of all ages because of the influenza vaccine. However, if some people do catch influenza the vaccine will make the illness less mild. USF should promote influenza vaccines to students, faculty and staff by offering the vaccine on campus at the USF Health Clinic. The vaccine offered will be convenient to those who do not have a motor vehicle. In addition, USF can work with health departments to reduce the price of…
The CHOC Children’s Breathmobile is the mobile asthma clinic dedicated to serving underserved children who may be unable to travel or pay for preventive asthma care in Orange County. As a volunteer, I helped nurses organize patients' charts, fax medical records, and confirm appointment schedules for patients' parents. Sometimes, I came with nurses and doctors to clinic sites to serve as a translator or simply shadow doctors. One doctor told me that regardless of whether the patients had insurance, the doctor would not turn anybody away if they were in need. Through this experience, I learned that the most gratification I could get is not receiving, but giving back to the…
There are many factors fused together that affect the health of communities and individuals. Whether individuals are healthy or not, is determined by their environment and circumstances. These factors include where we live, the condition of our genetics, environment, our education and income level, and our relationships with family and friends all have considerable impacts on health, considered that the more widely known factors such as availability and use of health care services often have less of an influence( World Health Organization (2010).…
Managed care contributes a vast amount to the healthcare system. Without managed care systems I don’t think health facility, insurances agencies and companies would manage. Agree, professionals are to adapt and accommodate changes based on contracts between managed care systems and other agencies. In my opinion, the technology advancement within the health care system has improved tremendously in a positive way. For example; when I switched my daughter primary doctor around shot time, me being old fashion handed her the paper shot record. She replied “ma’am it already imported into the system; we don’t use the paper anymore.” This is totally a successful and less stressful outcome on a person if it was to get lost or misplaced. These…
As a healthcare provider, I wish to give the best medical care to the patient but the dilemma would be patient would not be able to afford the cost of the medication without insurance reimbursement. To solve the problem, I can contact pharmaceutical companies for their patient assistance programs, patient and healthcare provider communication is strongly associated with the use of the programs (Gellad et al., 2011). Other possible solutions could be engaging social workers to assist patients to participate in Medicare Part D and financial assistance. We can also collaborate with other non-profit organizations for resources with prescription costs.…
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.…
These past five weeks have been a true eye opening experience I always knew that there were so many people who were uninsured or underinsured. Over these past five weeks I have learned so much about the healthcare industry and what is happening in the world around us. Many people tend to be blind when it comes down to the issues at hand. I fall into the statistic when it comes to being uninsured or not having enough coverage, it discourages people to seek the treatment that they need because they are scared of what is going to happen or if they are going to receive proper care like every other individual or treated differently because they don’t have insurance or money to pay it can be as simple as not being able to afford the treatment itself. I chose this particular topic to write my final assignment because I can honestly say that I can relate to this issue and it is a serious problem that has been facing Americans for a while now.…
I conducted an interview with Pleshetta Davis an administrator with Progressive HealthCare Providers. I decided to use a phone interview made by an online request. A letter was not used because mail delivery is often a problem this time of year. Pleshetta Davis was glad to be of service answering 10 questions that I had prepared for the interview, such as…
Tenet Healthcare Corporation (Tenet) a health care services company runs primarily general hospitals and other ancillary healthcare facilities. They are one of the largest investor-owned hospitals companied in the US. Tenet owned or operated 49 acute care hospitals( to include the infamous Memorial Hospital in the state of New Orleans famed after the horrific events following hurricane Katrina), and 59 outpatient centers in 11 states an 89 outpatient centers serving urban and rural communities. (Martin, 2006)…