Third Party Payers For this project, you will be providing information from the

Question

Third Party Payers

For this project, you will be providing information from the county you live in. It is important to know the local hospitals and healthcare environment when you graduate and apply for jobs.

Please list each question by number, followed by your answer to each after researching:

I. Insurance Companies:

Identify (5) commercial health insurance (carriers) companies (by name) that have provider networks in your county that offer either or both HMO and PPO plans and which one each offers.

Identify which commercial health insurance companies (by name) that have provider networks in your county that offer Medicare Part C Advantage plans.

   *Note: Some insurance companies might be listed in both answers to 1 and 2

II. Providers (Hospitals):

Now identify (5) hospitals (by name and city) in your county that participate in each of the provider networks identified above in both a. and b. (list hospital and insurance company names).

Classify each of the (5) hospitals identified as either for-profit, not-for-profit, or government owned.

What percentage (%) of patient admissions are classified as: a) Medicare, b) Medicaid/Charity, c) Commercial (private insurer) for each of the (5) hospital identified above?

III. Hospital inpatient procedure charges:

List and rank the (5) most expensive hospital inpatient procedures (treatments) by average total charge per procedure and the total dollar ($$) amount for each (use the most current year available) for each of the following payers: a) Medicare, b) Medicaid, c) Charity/Self Pay/Uninsured, and d) Commercial insurance?

For all the payers combined, what are the (5) most expensive procedures (treatments) by average total charge for each and the total dollar ($$) for each procedure?

   *Hint: The Agency for Healthcare Administration (AHCA) and floridahealthfinders.gov offer numerous statistical reports.

Explanation / Answer

I. Insurance Companies that give either or both HPO and PPO plans in india are:-

A. Bajaj Allianz Health Insurance

B. Religare Health Insurance

C. Royal Sundaram Health Insurance

D. United Health Care

E. Cigna Health Insurance

Commercial health Company that provide Medicare Part C advantage is Cigna Health Insurance.

II. The hospitals list that are participate in each of the provider networks:-

A. Sri sai maternity and General Hospital- for profit

B. Padmasri Hospital- for profit

C. V.N. Nursing Home Emergency Hospital- for profit

D. Aasha Hospital- for profit

E. Jeevana jyothi Hospital- not for profit

Patients admissions are classified as:-

Medicare- 27%, Medicaid/Charity- 13%, Charity/ Self paid/Uninsured- 33%, Commercial Insurance- 27%

III. The 5 expensive hospitals are:-

A. Lilavati Hospital, Mumbai

B. AIIMS, New Delhi

C. NIMHANS, Bengluru

D. Apollo Hospitals, Delhi

E. PGIMER, Chandigarh

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