Health care insurance
Risk, as defined by Nyman, is the element of uncertainty that occurs in a certain situation (p.8). These situations can either be foreseen or unforeseen and may lead to the loss of something of value. Based on these grounds, insurance comes in to diminish an individual’s level of risk.
On the other hand, Nyman defines insurance as the means by which risk is shared between the insured individual such as one who takes up the insurance as a risk-mitigating option and the insurer including one who offers the option of risk-sharing (p.15). In such situations, the buyer of the insurance packages pays a small fee to protect him or her against a potentially damaging loss. In most cases, the insurer is the insurance company that provides different insurance packages to individuals in an exchange for payment of a small fee that is referred to as a premium.
From the information discussed above, health insurance can be defined as the risk-sharing between an insurer and the insured with reference to the health issues affecting an individual (Nyman 17). In fact, medical bills may amount to large amounts of money that may dent an individual’s finances. Therefore, health insurance steps in to mitigate such situations. An example of an insurance company that specializes in offering health care insurance is the United Health Care (UHC).
The components of the United Health Care Choice Plus Standard package
The United Health Care provides different insurance packages with varying elements and conditions that suit an individual’s needs and financial status. In my case, I use the UHC Choice Plus which has a Standard Package. I have a co-payment agreement with the insurance company, which I acquired as a result of my employment contract.
In the Standard package, there are situations, in which I am required to pay a small fee to get some medical services while others do not charge any fees. In most cases, such an arrangement has a co-payment plan. According to Kongstvedt’s assertions, a co-payment can be defined as the amount one is required to pay during hospital visits (p.12). As per my health insurance package, I am not required to pay any amount of money when making preventive visits to the doctor. The arrangement usually means that I can visit the doctor from time to time and have regular body checkups at no cost. In most cases, such a situation helps in assessing the state of my health as well as assists the doctor in diagnosing any ailments I might have at an early stage. Furthermore, I have a co-payment plan when I intend to make the primary care office visits. For instance, during any primary care office visits, I am required to pay $30. However, for more specialized visits, I am required to pay $40. As a result, the plan makes financial sense as I am spared the burden of paying a hefty bill.
When a medical emergency comes up as per my insurance package, I am only required to pay $50 for Urgent Care. The situation is helpful given that there may be instances where I might be financially strained and would have had to pay a high price to access Urgent Care. As a result of technological advancements, health care has become very accessible to the majority of individuals. Therefore, one can access the available professional medical consultation that is accessible online. The situation is often referred to as telehealth. Darkins and Cary define telehealth as the use of information and communication technology to exchange medical information from one site to another (p.22). As per my UHC Choice Plus with the Standard package, I only pay $38 for every consultation I make to use this service. My insurance package also involves an out-of-pocket payment of $30 for every office visit. Buchbinder and Shanks define the out-of-pocket payment as the money that one pays for health care services offered during the office visits in one calendar year (p.22).
In situations that require an Emergency Response (ER), I am required to pay $250 for every visit that I make as stipulated in the co-payment plan, which integrates my health care package. Annual deductible refers to the amount of money required to offset medical expenses in one calendar year (Paolucci 20). I am required to pay $900 for the single option in the insurance plan as the annual deductible fees or $1800 if one takes the family option.
All in all, the UHC Choice Plus Standard package involves a co-insurance arrangement of 80%. The situation means that the insurance company pays 80% of the medical-related bills while an individual is required to pay the remaining 20% of the expenses.
When it comes to the choice of the providers, the United Health Insurance requires its beneficiaries to choose a primary care physician. In this case, one is required to use the services of doctors, specialists or hospitals that accept UHC Care as one of their insurance payment options. However, in situations where UHC Care is not accepted as a payment option, one can make an out-of-pocket payment while the insurance company covers the remaining 50% of the cost. The primary advantage of using UHC Insurance is that there is no limitation on the use of out-of-network providers. Therefore, one is not restricted to using the providers only approved by the UHC.
The processes involved in seeking healthcare
The annual physical tests are essential in diagnosing any ailments at an early stage. The United Health Care members are required to undergo these tests from their selected Primary Care Physician (PCP) for a $0 co-payment plan. The individuals are required to book their appointment with their PCP. Eight hours prior to the booking, one is advised to fast and drink only water. The situation enhances the accuracy of tests such as cholesterol or blood glucose. The components tested include blood glucose, blood pressure, total cholesterol, triglycerides and pulse (United Healthcare par.2).
When seeking specialist care under the UHC insurance, one is advised to use the in-network providers. These are providers who are recognized by the insurers and are part of the United Health Care Choice Network. In this case, using these providers warrants low deductibles, copayments and coinsurance. Therefore, one saves more money compared to using providers who are not part of the UHC network. One is required to find a provider using the online UHC directory or contact the insurance agent directly to book their appointment.
When one needs to be admitted for elective surgery, one is required to read and understand the policy documents provided by the UHC insurance. Such an undertaking enables one to understand the procedures covered by the insurance package. In addition, one must be able to provide documentation, which indicates that the condition has the ability to impede body functions. Furthermore, there must be sufficient proof that the procedure will improve the patient’s overall physiological functions. Provided the coverage has been verified, one can go ahead and book an appointment with the Primary Care Provider.
Works Cited
Buchbinder, Sharon, and N. Shanks.Introduction to Health Care Management. Burlington, Mass: Jones & Bartlett Learning, 2012. Print.
Darkins, Adam, and M. Cary.Telemedicine and Telehealth: Principles, Policies, Performance, and Pitfalls. New York, NY: Springer, 2000. Print.
Kongstvedt, Peter. The Managed Health Care Handbook. Gaithersburg, Md: Aspen Publishers, 2001. Print.
Nyman, John. The Theory of Demand for Health Insurance. Stanford, California: Stanford Economics and Finance, 2003. Print.
Paolucci, Francesco. Health Care Financing and Insurance: Options for Design. Berlin: Springer, 2011. Print.
United Healthcare.United Healthcare Services, Inc, 2015.Web.