Healthcare Medical Insurance Discussion.
Healthcare Medical Insurance Discussion.
These post replies need to be substantial and constructive in nature. They should add to the content of the post and evaluate/analyze that post answer. including one scholarly peer-reviewed reference. Minimum 100 words. Investing in one’s health is essential to a peaceful and happy life. Saudi Arabia’s Council of Cooperative Health Insurance (CCHI) mandates that all citizens have health insurance. Dental and optical treatment, inpatient and outpatient care, and hospitalization are all included(Alkhamis, 2017).
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Compensation claims should be sent to the insurance provider, along with additional papers, as soon as possible after an incident occurs(Worth & Mytinger, 1996). The insurance coverage you purchase is a pledge of help in the event of any illness. If the insurance covers the circumstance, the insurer will assess your claim, and in order to do so, you will need to produce authentic proof. A smooth claim process is a goal for insurance companies, but the policy receptacle moves at its own pace during the claim process. There are a few steps to take before you may file a claim(Umemoto et al., 2019).
The insurance company will pay attention to the small details if you put your act together well and work efficiently. Making a claim is a painless and straightforward process that anyone may do. Your insurance company should be contacted very away, especially in cases involving severe health issues such as critical illness, disease, or incapacity. Product disclosure report assessment is also an option to see whether this isn’t on the list of rejected policies. Once you file a claim on your insurance policy, your insurance company will do this for you as well(Worth & Mytinger, 1996). In addition, the hospital will be able to verify the insured’s identity and specifications. The hospital will then submit the pre-consent document to the insured’s medical insurance provider.
The insurance provider will inquire about the compiled report and proceed with the claim following the medical insurance policy’s terms and circumstances. Despite insurance companies’ best efforts to make claims as flat as pancakes, these claims take an average of 15 to 30 days to process, even though these processes are simple to apply. If you have enormous medical expenditures that necessitate thorough examination on many levels, it could take months(Umemoto et al., 2019). It’s critical to stick to these timelines if you want to steer clear of inaccurate or skewed information. When a person’s insurance claim is being verified, they are either experiencing all of these conditions or lying to get the money they deserve. In addition, submitting a fake insurance claim is punishable by law. As previously stated, these claims are often resolved within 15 to 30 days. As a result, the insurer does everything in its power to accommodate the insured as quickly as possible, knowing that a timely resolution benefits both parties(Albejaidi, 2018). References Albejaidi. (2018). Emerging Role of Cooperative Health Insurance in Achieving Health System Goals under Saudi Vision – 2030. Journal of Biology, Agriculture and Healthcare, 8(2), 1–8. Alkhamis, A. A. (2017). Critical analysis and review of the literature on healthcare privatization and its association with access to medical care in Saudi Arabia. Journal of Infection and Public Health, 10(3), 258–268. https://doi.org/10.1016/j.jiph.2017.02.014 Umemoto, K., Goda, K., Mitsutake, N., & Kitsuregawa, M. (2019). A prescription trend analysis using medical insurance claim big data. Proceedings – International Conference on Data Engineering, 2019-April, 1928–1939. https://doi.org/10.1109/ICDE.2019.00209 Worth, R. M., & Mytinger, R. E. (1996). Medical insurance claims as a source of data for research: accuracy of diagnostic coding. Hawaii Medical Journal, 55(1), 9–11. These post replies need to be substantial and constructive in nature. They should add to the content of the post and evaluate/analyze that post answer. including one scholarly peer-reviewed reference. Minimum 100 words. Incidents triggering the medical insurance Even though the customers may have basic medical insurance for themselves, there are chances that certain incidents may trigger the medical insurance. The medical insurance gets triggered when the loss faced by the customer is not added in the compensation or may exceed the limit of the compensation.
Describing such a situation can have the example of the basic road accident of the insured that has to be compensated by the company (Ahmed & Abdullah, 2020). Medical insurance can be triggered when the losses are much higher than the allowed value, and that occurs spontaneously. The pathway that can be used to claim insurance The basic pathway that is used to have the claim back is to wait for the compensation for 30 days, at least after you have registered your loss. Certain companies may extend the compensation period for many days in case of some clarification or documentation issues. Considering the case described above, a client can make their medical insurance increased with the extended services, or he can either extend its plan to a more premium one. The pathway chosen can make the delays in compensation for a more extended time (Alkhenizan & Shafiq, 2018). The time frame needed Insurance companies often require time frames to provide complete compensation for the loss.
These time frames vary from state to state can usually be 30 to 45 days. In case of an emergency situation that can trigger the present medical insurance, the company may ask the insured for compensation extension as the policy has to be redefined. In other cases, if the insured wants to move to more premium packages, the extension may also lead to different time phrases. The importance of these time phrases include the settlement periods that is crucial for the client and the company to initiate the compensation and to redefine the circumstances for future compensation (Valerius et al., 2019).
Reference Ahmed, M. H., & Abdullah AL Amri, T. (2020). The Impact of Privatizing Health Insurance on the Utilization of Medical Services in the Kingdom of Saudi Arabia. Sustainable Development and Social Responsibility—Volume 1, 255–267. https://doi.org/10.1007/978-3-030-32922-8_25 Alkhenizan, A., & Shafiq, M. (2018). The process of litigation for medical errors in Saudi Arabia and the United Kingdom. Saudi Medical Journal, 39(11), 1075–1081. https://doi.org/10.15537/smj.2018.11.22854. Valerius, J., Bayes, N., Newby, C., & Blochowiak, A. (2019). Medical Insurance: A Revenue Cycle Process Approach (8th ed.). McGraw Hill. Question Describe a situation that would trigger a medical insurance claim. Describe the path taken to resolve the insurance claim and any time limits that must be met in resolving the claim. Why do you think these specific time frames are important? Be sure to support your statements with logic and argument, citing any sources referenced. Answer
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.
ADDITIONAL INSTRUCTIONS FOR THE CLASS
Discussion Questions (DQ)
Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation
Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality
Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes
I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy
For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy
The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading. Healthcare Medical Insurance Discussion.
Communication
Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours. Healthcare Medical Insurance Discussion.
Healthcare Medical Insurance Discussion.