In the claim filing process, there are private and public payers that have their own characteristics and differences. Hence, the first ones pay for medical services on their own, or their employer does it, when the latter receive assistance from state funding (Reinhardt, 2018). A medical claim is an invoice that is provided to the patient’s insurance company depending on which type of insurance was chosen by individuals. The main difference between private and public payers is that public payers have only such insurance options as Medicare and Medicaid, while private ones are given a much more excellent choice. Another difference is the difference in price since private requires much more financial spending. At the same time, it guarantees a higher quality of service and medical services. Last, in cases where the state pays for medical services as part of insurance, reimbursements for healthcare organizations are significantly less than for private payers.
During the claim filing process, several ethical issues may arise that require consideration. First of all, the most critical problem may be the dissemination of personal information about the patient. This is one of the most critical threats, not only to the privacy of the client but also to the reputation of the medical organization, which requires specific measures that will limit the possibility of this problem. The second ethical problem may be charging customers for services they did not receive. This phenomenon is called phantom billing and is quite common in medical practice. To solve this issue, institutions must have a well-organized and effective monitoring system. Another problem may be the fact of a violation of accessibility in the provision of medical care to patients.
Reference
Reinhardt, U. (2018). The public private mix for health. CRC Press.