by Mitul Jayendrabhai Shah Roll no- 121224 MBA FT – SECTION B Institute of Management – Nirma University 14TH August 2012 EXECUTIVE SUMMARY Quality Care is a US based reputed Health Maintenance Organization (HMO). Allan Moulter‚ CEO of Quality Care is in dilemma to install computerized system or not because of the uncertain behaviour of customers. The objectives are to retain existing customers‚ to maintain customers’ satisfaction
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SECONDARY HIC / COVERAGE SIMILAR TO PRIMARY / SUPPLEMTAL HIC COVER ONLY DED‚ COPAY‚ COINS MCR SUPPLEMENTED BY MCD MEDI / MEDI * Follows MCR guidelines for filing deadlines * MCR beneficiaries w/ low incomes – limited resources may get help from MCD * MCR/ FULL MCD eligible (MCR is supplememted by MCD services from the state) a) more than 100 day limit for SNF ‚ b) rx c) eyeglasses d) hearing aids DUAL ELIGIBLES * MCR low income/ lmt resources (may receive
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CDHPs and the Importance to Consumers CDHPs and the Importance to Consumers Introduction For sure‚ consumer-driven health plans (CDHP) have been around since the 1990s‚ since its inception by health e-commerce ventures. CDHP is a saving account that is pre-taxed‚ and is to be used for medical expenses. In-network providers’ discount may are sometimes offered‚ however‚ it is not offered to enrollees who are restricted to choose their own treatment centers or health care providers. In this
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Blue Cross Blue Shield of South Carolina Shauna McKinnon Health Care Systems 235 University of Phoenix 2011 The name of the agency of my selected provider is Blue Cross Blue Shield of South Carolina. I researched different websites to obtain my information about Blue Cross Blue Shield. I researched Blue Cross Blue Shield of South Carolina‚ which was updated in 2011‚ Manta Media
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Humana is one of the leading health and well-being companies in the United States. Their focus is to make it easy for individuals to maintain their best health with excellence through coordinated care. Some of their strategies include care delivery‚ proactive outreach clinically‚ clinical and consumer insights and member experiences. In the year 2016‚ over 70 percent of their total services revenue and total premiums were from the federal government‚ fourteen percent of which was derived from their
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Condition A preexisting medical condition is a physical or mental illness that you had in the past or present that needed treatment. The Affordable Care Act removes all preexisting medical conditions from people. HMO An HMO is part of the health maintenance organization that only allows you to see a network provider. You are required to select a PCP in order to obtain a referral to a specialists. The patient had a Humana HMO policy that we do not accept. Affordable Care Act The Affordable Care Act
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services and products to individuals and continuing to update as technology changes ‚ so that they can better serve individuals with the latest treatments‚ doctors and products available. Insurance is make up of several aspects like HMOs (health maintenance organizations)‚ PPOs (preferred provider organizations) and many subsystems. For example‚
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views. Nowadays it doesn`t matter who you are: a soldier‚ an unmarried mother‚ an old man‚ the main point is your possibility to pay. Money‚ money‚ money. That person survives‚ who has much money on a bank account. Michael Moore compared health maintenance organizations (HMOs) in America to free‚ universal care system in France‚ Canada‚ and The Great Britain. And the results are astounding. The same stories of different people ended in diverse ways. And the reason for
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In December 1998‚ Aetna announced that it would purchase Prudential Health Care from Prudential Insurance Company for $1 billion in cash and debt. The merger created the biggest healthcare company in the United States with 22.4 million customers (Freudenheim). In July of the same year‚ Aetna had just purchased NYLCare from New York Life Insurance to become the fourth largest managed-care company‚ and it was still in the process of integrating (3-99 CV 398-H). The Prudential Health Care merger was
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retrospective‚ or concurrent? Who pays for care? What is the access structure‚ such as gatekeeper‚ open-access‚ and so forth? How does the model affect patients? Include pros and cons. How does the model affect providers? Include pros and cons. Health maintenance organization (HMO) Example: HMOs first emerged in the 1940s with Kaiser Permanente in California and the Health Insurance Plan in New York. However‚ they were not adopted widely until the 1970s‚ when health care costs increased and the federal
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