BHA FPX 4009 Assessment 2 Reimbursement Options Part 2 – Payment Options for Uninsured Patients Identify and Explain Payment Options for Uninsured

The cost associated with seeking medical treatment in the United States becomes extremely expensive, especially for individuals who are not able to secure health insurance. While there have been many efforts to address the need to expand insurance to individuals who cannot afford it, there are also options such as Medicaid, financing options, and charity care to assist those who are uninsured. Medicaid is a joint state-federal program that reimburses for health services received by individuals and families that are considered low-income (Casto, 2019A). Medicaid covers some of the poorest individuals and families in the country (Rosenthal et al., 2016). This is important coverage for this population as patients covered by Medicaid have worse health status than those who have private insurance (Rosenthal et al., 2016). After the passing of the Affordable Care Act, individuals with incomes up to 138% of the poverty level in participating states are eligible for Medicaid (Cannon et al., 2018).

Another option for individuals who are uninsured is setting up a financing payment system with a doctor’s office or using online companies or banks that offer medical financing loans. To qualify for financing, the patient would apply with the financing company who would use the patient’s tax returns, bank account information, and/or paychecks to determine the monthly payment and interest rate. Unlike other debts, there is more room to negotiate payments for medical bills (Lamberti, 2021). In addition, physician offices and hospitals may also offer a discount for self-pay patients. Rather than trying to

get on a payment plan, where the individual may pay interest, paying a medical bill in one lump sum will often result in a discounted rate. For example, if a patient agrees to pay the $500 new patient consult fee within 30 days of the visit, the billing department could offer to take 10% off the rate as long as the full amount is paid by a certain date (Lamberti, 2021).

Conclusion

Healthcare professionals should have a clear understanding of the reimbursement systems in the industry as their potential impact on patients’ lives and the income for the healthcare organization could be affected (Casto, 2019A). Understanding the different reimbursement models is important for the healthcare facility to know how their payments will be received for the services they have provided and to know the best way to provide those services for maximum reimbursement and quality care depending on the payment method. While all of the mentioned forms of reimbursement are still in use today, all major payment reform efforts have included using performance-based models that include bonuses for quality, patient experience, and cost control (Rosenthal, 2007).

References

Cannon, R. B., Shepherd, H. M., McCrary, H., et al. (2018). Association of the Patient Protection and Affordable Care Act with Insurance Coverage from Head and Neck Cancer in the SEER Database. JAMA Otolaryngology Head Neck Surg. 144(11). Retrieved from https://pubmed.ncbi.nlm.nih.gov/30242321/