THIS TASK WILL ALLOW YOU TO EXAMINE THE COMPLEXITY OF THE HEALTHCARE REIMBURSEMENT SYSTEMS AND BEGIN TO COMPARE THE SIMILARITIES AND DIFFERENCES BETWEEN THEM.
Section A
This task will allow you to examine the complexity of the healthcare reimbursement systems and begin to compare the similarities and differences between them. To complete this task, read the attached “A Lifetime of Healthcare Services,” which is a case scenario about a woman named Sophie. Then create a multimedia presentation, diagram, table, or other illustration comparing the differences and similarities among the various insurance options and reimbursement systems that were used to pay for Sophie’s medical care throughout her lifetime.
You are explaining these reimbursement systems from the perspective of a billing department manager training two new staff members. You believe that if you can explain these systems with a real patient, it will be easier for your new staff to understand the various requirements of these reimbursement systems.
A. Compare Sophie’s health insurance options for each of the five phases of her life.
1. Recommend the health insurance option that would provide the best coverage to meet Sophie’s needs during each phase.
a. List the elements of each plan you recommended.
b. Discuss the reimbursement requirements of each plan you recommended.
c. Discuss restrictions to each plan you recommended.
B. When you use sources, include all in-text citations and references in APA format.
Note: When using sources to support ideas and elements in a paper or project, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the paper or project.
Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the General Instructions section.
A Lifetime of Healthcare Services
Phase 1
When Sophie was first married, her husband worked in a meat packing plant. His job
offered an optional health insurance package that could cover Sophie’s husband, Sophie,
and their family. Sophie did not have a job; she stayed home to care for their five children
and an elderly parent. Many years passed. Sophie and her husband raised their children,
and her elderly parent died. Sophie’s husband looked forward to retirement.
Phase 2
Sophie’s husband died before he reached retirement age. His company offered his benefits
plan to Sophie, which she could enroll in indefinitely if she chose to do so. This plan would
include good drug benefits. The insurance plan through the company had become a
managed care plan over the years. Sophie decided to remain with her husband’s insurance
plan.
Phase 3
Sophie turned 65. She was on a tight budget and did not like the idea of paying a monthly
premium. However, she wanted her insurance to provide many physician and service
options. She also wanted a good drug coverage plan.
Phase 4
Sophie’s health declined. She was hospitalized for several days after a fall and received
home healthcare for several weeks. She was diagnosed with Alzheimer’s disease about a
year later and could no longer safely live alone. Sophie moved into an assisted living facility,
and her daughter took over the financial management of her assets. In addition to other
financial obligations, Sophie needed to pay for the cost of rent for the facility.
Phase 5
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