I am currently in UOP HCS 235. I am currently working on the health insurance matrix worksheet and I am stuck big time. Here is what I have done so far. It is due in 4 hours and I need major help. the blank boxes I have no clue what to write.

Health Insurance Matrix HCS/235 Version 7 1 University of Phoenix Material Health Insurance Matrix As you learn about health care delivery in the United States, it is necessary to understand the various models of health insurance to develop important foundational knowledge as you progress through the course and for your role as a future health care worker. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers. Fill in the following matrix. Each box must contain responses between 50 and 100 words and use complete sentences. Model Health Maintenance Organization (HMO) Preferred Provider Model Describe the model This type is a managed care and it has a list of covered doctors, hospitals, and other health care providers that are in the network with HMO's. Out of network doctors are only covered in an emergency situation. Usually requires a referral from your doctor for specialist. Generally consist of preventative and wellness care. This type is managed care and generally contracts with doctors, hospitals, and other health care providers for a discounted price. You can use any doctor whether it is on their list or not and it will be covered, just at different rates. Doesn't require a referral to other doctors as long How is the care paid or financed when this model is used? With managed care plans they are financed through three types of payments; capitation, discounted fees, and salaries. Capitation is a fixed monthly rate per member to the provider. Discounted fees are used when providers agree to discount their fees for a volume of business. All providers are on a salary basis so they only receive a part of the compensation. The rest is distributed at the end of the year as a bonus. It is financed through three types of payments; capitation, discounted fees, and salaries. Capitation is when the provider gets a monthly set fee for their services provided. Discounted fees are used when providers agree to discount their fees for a volume of business. Salaries are how providers are paid. What is the structure behind this model? Is it a gatekeeper, openaccess, or combination of both? Health maintenance organizations are a gatekeeper insurance. They require that you have a personal care provider (PCP) which makes all of your referrals to any specialist. You cannot see a specialist without a referral from your PCP. Specialist are; cardiologist, gynecologist, oncologist, urologist, neurologist, endocrinologist, gastroenterologist, dermatologist, and many more. Preferred providers are a combination of both gatekeeper and open-access. You do not need to have a referral from your personal care provider (PCP) in order to see any specialist or other doctors as long as they are in the network. If you go out of the network you will have to have a referral. Copyright 2016 by University of Phoenix. All rights reserved. What are the benefits for providers in using this model? What are the challenges for providers in using this model? Health Insurance Matrix HCS/235 Version 7 as it is an in network doctor. Point-of-Service Model This type is managed care and has some characteristics from both HMO's and PPO's. It is a lower cost insurance plan if you use the doctors within the network but it also requires a referral from your primary physician in order to see any specialists. Patients are required to send their own bills and paper work in from out of network doctors. Provider Sponsored Organization They receive a partial payment and at the end of the year receive the rest as a bonus. This type of insurance is managed by a group of doctors, other medical professionals and hospitals that forms a network of providers. In order to receive care you must stay within that network. They require a set amount of money each month from Medicare to deliver the care to the patients. This is offered by employers and set up with an account to cover out of pocket expenses. These accounts are health reimbursement arrangements (HRA's), which are funded by the employers, and health savings accounts (HAS's), which are funded by the individuals. These High Deductible Health Plans and Savings Options Point of service insurances are also a gatekeeper. Even though they have many features from both health maintenance organizations and preferred provider organizations it is required to have a referral from your PCP in order to see any specialist, whether it is in the network or out of the network. Copyright 2016 by University of Phoenix. All rights reserved. 2 Health Insurance Matrix HCS/235 Version 7 are done on a preincome tax basis, and generally done on a payroll deduction. Cite your sources below. For additional information on how to properly cite your sources check out the Reference and Citation Generator resource in the Center for Writing Excellence. References HMO's, PPO's, and POS Plans. (n.d.). Retrieved from http://www.agencyinfo.net/iv/medical/types/hmo-ppo-pos.htm Copyright 2016 by University of Phoenix. All rights reserved. 3