HCS Fall 2020 Insurance Project Answer These Questions To Th ✓ Solved

Hcs Fall 2020 Insurance Projectanswer These Questions To The Best Of Y

Answer these questions to the best of your ability using your health insurance plan. Sometimes it can be challenging to find these details, but that is part of the assignment. If you don’t want to use your health insurance plan or don’t have health insurance, you should use the UTSA student health insurance plan to answer the questions. Unless specified otherwise, answer cost questions based on both the in-network and out-of-network costs, as circumstances may require using providers outside your network.

1. Is your plan a private or public insurance plan; how did you determine this?

2. What type of plan do you have? (PPO, HMO, etc.)

3. When is your open enrollment period (when you can make changes to your insurance)?

4. What is your premium (usually the amount you pay monthly or per semester for a student plan)?

5. What is your individual and/or family deductible?

6. What is your cost for preventative/wellness care?

7. What is your cost to see your primary care doctor (may be listed as a diagnostic visit)?

8. What is your cost to see a specialist?

9. What is the cost for diagnostic lab tests and x-rays?

10. What is the coinsurance or copayment for durable medical equipment?

11. Does your insurance cover genetic testing? If so, which ones and under what circumstances?

12. If you have private insurance, which classifications apply to your plan (MC, group, self, HDHP, individual)?

13. If you have an HDHP, do you have an HRA or HSA? a. If you have a public insurance plan, exchange plan, or military plan, do any of the above apply?

14. You were hiking and took a fall. You go to the nearest urgent care center (not checking if it's in-network). They decide an x-ray is necessary. The x-ray shows no fracture. You are prescribed generic pain medication. Assume negotiated rate: x-ray $500; medication $50.

a. How much will you pay out of pocket for the visit? For the x-ray? b. How much will you pay for the medication? c. How much more would you have paid to access an emergency room?

15. It’s time for your annual wellness visit. You see your primary care provider. You receive a recommended immunization, and your PCP orders additional blood work due to recent concerns. a. How much is the cost of the visit? b. Do you have to pay for the immunization? c. How much will the blood work cost you (assumed negotiated rate $100)?

16. You or a female on your insurance plan was pregnant and delivered a healthy baby. The hospital stay cost $4,000, and delivery costs are $8,000. You’ve met your deductible. Assume hospital and provider are in-network.

a. How much will you/her be responsible for paying for delivery costs? b. How much for facility costs?

17. You experience severe pain and fever at work. An ambulance takes you to an in-network ER. You require an emergency appendectomy. Deductible met. Transportation $1,000; physician/surgeon $10,000; facility $12,000.

a. How much will you pay for transportation? b. How much of the physician/surgeon fees? c. How much of the facility fees? d. The surgeon is out-of-network, and you get billed $1,000. How much will you pay, and why?

18. Do you think your insurance plan is “good”? Why or why not?

19. What changes would you consider for next year’s open enrollment?

20. If your health changed dramatically over the next year, would this plan still meet your needs at a feasible cost?

Sample Paper For Above instruction

Health insurance plans are integral to managing healthcare costs and accessing necessary medical services. Understanding the specifics of one's plan, including coverage, costs, and restrictions, enables consumers to navigate the healthcare system effectively and make informed decisions during open enrollment periods and in response to urgent health needs.

My health insurance plan is a private PPO plan obtained through an employer. I determined this by reviewing my insurance card, which explicitly states the provider type, and by examining the provider networks, which include both in-network and out-of-network options. PPOs offer flexibility to see any physician without a referral, which I confirmed from my plan documentation. The open enrollment period for my plan is from November 1 to December 15, aligning with my employer’s benefits calendar. My monthly premium is $350, totaling $4,200 annually, and my individual deductible is $1,000. The family deductible is higher but not applicable as I am covered individually.

Preventive and wellness care services are fully covered by my plan with no copayment, complying with preventative service mandates under ACA regulations. To see my primary care physician, I am responsible for a $30 copayment per visit, whereas visiting a specialist incurs a $50 copayment. Diagnostic lab tests and X-rays are covered at negotiated rates, with X-rays costing approximately $200 in-network, while out-of-network rates average around $500. Durable medical equipment such as crutches or wheelchairs have a copay of 20% under my plan.

My plan covers genetic testing only under specific circumstances, such as if the tests are recommended by a healthcare provider to diagnose or rule out certain hereditary conditions, with prior approval. I have a PPO classification, which qualifies as a group plan through my employer. I do not have an HDHP, HRA, or HSA; thus, these do not apply to my coverage. There are no public exchange plans, military plans, or other government programs involved in my insurance.

Recently, I experienced a fall during a hiking trip, leading me to visit an urgent care center. The in-network negotiated rate for an X-ray was $500, and I was prescribed $50 worth of generic pain medication. Because I do not have to pay the full negotiated rate in out-of-network scenarios, my out-of-pocket cost for the visit was $100, assuming a 20% copay structure typical of my plan. The medication, being generic, cost me $15 copayment. If I had gone to the emergency room instead, the costs would have significantly increased—ER services would typically cost around $3,000 to $5,000, and I estimate my share could have been approximately $1,000 depending on copayment and coinsurance agreements.

For my annual wellness visit, which is fully covered without copayments, my provider recommended immunizations that were also covered at no out-of-pocket cost. Additionally, my provider ordered blood tests, which my plan covers at a negotiated rate of $100, causing me to pay only that amount. The overall cost for this preventive care was minimal, emphasizing the value of comprehensive coverage for routine health maintenance.

If I had been pregnant and delivered a baby, I would be responsible for certain costs depending on my deductible status. Given that I met my deductible, my portion of the delivery costs—including hospital and miscellaneous facility costs—would be reduced significantly. Typically, in-network delivery costs include the hospital stay of $4,000 and uncomplicated delivery charges of $8,000. My personal responsibility would primarily entail copayments for hospital services and possibly some coinsurance for facility fees, but overall, costs would be lower due to prior deductible payments.

In an emergency scenario requiring an ambulance and in-hospital surgery for appendectomy, I would be responsible for transportation costs, physician fees, and facility charges. Ambulance services often cost around $1,000, which my plan partially covers, leaving me with a copay. The surgeon and physician fees, totaling $10,000, are generally covered by in-network benefits, with patients often responsible for a coinsurance of 20%. The hospital facility charges amount to $12,000; after deductibles and copayments, my responsibility could be around $2,400 to $3,000 depending on the specifics of my coverage.

Regarding the out-of-network surgeon billing, Texas law imposes certain protections against balance billing for in-network hospital services; however, if a provider is out-of-network, balance billing can occur. Since the surgeon was out-of-network, I might have to pay the balance bill of $1,000 unless Texas laws protect against such charges, which many do not; thus, I would be liable for that amount. This highlights the importance of verifying provider network status before procedures.

Reflecting on the insurance plan, I consider it a good plan because it offers comprehensive coverage, reasonable premiums, and protection against high medical costs. Nonetheless, areas of improvement include expanding coverage for out-of-network emergencies or reducing copayments for specialist visits. During open enrollment, I would consider increasing my preventive care coverage or lowering premiums.

If my health changed significantly, such as developing a chronic illness, I would reassess whether this plan meets my needs, including prescription drug coverage and specialized treatments. If the costs become unaffordable, I might look for plans with lower premiums but better coverage for my new health circumstances.

References

• Kaiser Family Foundation. (2022). How Health Insurance Works. https://www.kff.org/health-reform/health-insurance-coverage/
• Healthcare.gov. (2023). Understanding your health insurance. https://www.healthcare.gov/
• Texas Department of Insurance. (2022). Balance Billing Protections. https://www.tdi.texas.gov/
• Centers for Medicare & Medicaid Services. (2023). Preventive Services Covered by Private Health Plans. https://www.cms.gov/
• National Conference of State Legislatures. (2021). Laws Limiting Balance Billing. https://www.ncsl.org/
• American Hospital Association. (2021). Hospital Charges and Cost-Containment. https://www.aha.org/
• Consumer Reports. (2022). How to Understand Your Health Insurance Bills. https://www.consumerreports.org/
• HHS.gov. (2023). Protecting Consumers against Surprise Billing. https://www.hhs.gov/
• Health Affairs. (2022). The Impact of Insurance Type on Healthcare Costs. https://www.healthaffairs.org/
• National Institutes of Health. (2021). Genetic Testing and Counseling. https://www.nih.gov/