Nothing is more important than YOUR Health!
Payment for Healthcare Services
The United States is known worldwide for providing excellence in healthcare.
In fact, anyone can access and experience any healthcare diagnostic and treatment modality that is evidence-based and ordered by a licensed practitioner of medicine. However, it must be paid for and is exceedingly expensive compared to worldwide healthcare costs for similar services. Control of the ever-increasing cost of healthcare in the USA has yet to be achieved despite many national efforts.
Two of the important guiding principles that actively dictate the practice of medicine in the United States that you should fully understand:
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“Medical Necessity” as defined by the “Standard of Care” and “Evidence-based medical science”
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Third-party payer ie. Healthcare Insurance
Cost and Payment principles and strategies available within the United States
The charge of each medical care service in the United States is determined by the provider of that service. All services are coded and the diagnosis (69,000) code must be medically consistent with the services provided and charged for.
Facts you should know
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In general, costs have accelerated annually for decades.
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Fee-for-Service: Full payment for all provided services by the patient.
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Public Health Services: Various specific services available locally to all residents, often free or paid for on a sliding scale.
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Third-Party Payer or Healthcare Insurance: Most frequently provided and paid for in part or whole by an employer.
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Managed Care:
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An insurance strategy designed to control costs by paying for only medically necessary services from selected, contracted networks of providers who have agreed to provide services to policyholders at a specifically negotiated discounted fee.
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Its major problem is that, although it has influenced cost favorably, it limits personal choice of providers to its contracted networks and often requires prior approval for services and/or only covers the cost of a specific limited choice of services.
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Types of plans include HMOs, PPOs, and Point of Service plans.
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Concierge Medical Services: An individual provider contracts with a patient to accept the patient’s insurance but also requires a significant annual payment by the patient to receive very personalized medical professional services. To accomplish this, the provider generally limits the number of active patients in the practice.
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Legally, all licensed providers of service can use the court system and its remedies to collect any personal financial obligation from patients served.
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Some providers of care will provide payment plans and/or discounts upon request by the patient. Such payment services are not ethically or legally required but are provided as a courtesy to the patients of the practice.