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Ever since the beginning of healthcare there were policies and economic standards set into place, although not all at once, to better help distribute the monies involved with receiving healthcare. These third-party payors such as Medicare/Medicaid were originally established on July 30th, 1965 and originally only had part A and B. This limited what the patients could receive for coverage until 1972 when it was expanded to include coverage over more diseases, infections, mental issues. It was not until after this that part D (prescriptions) were introduced and since then, they have grown to become what it is now.
This would directly relate to the individual’s health primarily because if Medicare/Medicaid did not cover it, you would end up paying out of pocket (self-pay) which if individuals knew something was not covered, they would not go in for help. Healthcare I am learning is not as cut and dry as it should be and includes a lot of gray area.
For instance, with doing medical billing, if there is a claim not covered by Medicare for a patient it could be covered under a different insurance such as Health Partners which follows Medicaid guidelines. (CMS, 2018)
The biggest impact from the insurance companies today would be the out of pocket that the patient may or may not end up paying. If the insurance covers the cost of the visit with a simple copay, fine, if the patient ends up paying $1000 worth of expenses, said patient probably will end up not going back for same/similar treatment based off paying that amount.
The deductible is a fixed amount (does not change throughout the year) that the patient must pay before insurance kicks in. If the deductible is higher, that means the patient pays more out of pocket before the insurance benefits that you already get taken out of the paycheck before they help. This will impact the individual because when choosing a new health insurance, at least in my experience and listening to other people, the amount of the deductible will impact what type of insurance is chosen. (Elizabeth Davis, 2018)
There are a lot of different moving parts when it comes to healthcare and I am learning more in this class with the economic part in detail. There is still a lot to learn from this, but people are more educated on what to ask during the hospital visit, they are more curious and assertive with what they want and expect and hopefully this will carry on to a reform of the policies put into place for coverage. Based off from other classes here at Purdue University Global such as my coding class, the United States is the only place that pays as much as we do and in the sense of coding claims for reimbursement, we are still far behind the rest of the world as we just upgraded to the ICD-10 system when places such as Europe were already using it years before us.
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