Essay On Managed Care

Across America there are millions of individuals that received healthcare coverage. Almost all of the fifty states have passed consumer and patient protection laws and regulations and the details to how these laws are stated vary considerably such as with New York and Florida. It is important that patients medical and health information be protected by these laws and regulations as well as consumers to insure patients rights are not violated and patient care within the scope of these laws and regulations. New York and Florida laws and regulations regarding patients and consumers have similarities and differences and both must follow the Health Insurance Portability and Accountable Act (HIPAA) privacy rules, which is a federal law and is part of each states laws and regulations (Managed Care State Laws and Regulations, Including Consumer and Provider Protections. 2010, May). One similarity both states follow is the law that shields patients from surprise medical bills. Furthermore, this law applies to patients that use their health plan provider in-network benefits. For instance their use an in-network hospital for an emergency services and inadvertently receives services from a non-network provider. Patient will only be responsible for paying their usual

Despite the fact that both state are contracted with many health plans, those contracted in New York may participate in more than program and selects its plan based on its competitive procurements and set plan rate using an actuarial process, while those contracted in Florida are for-profit and affiliated with national insurance carriers and select their plans under its two risk-based programs. It rates are set by using utilization data drawn from plan-reported encounter reports (Profiles and Data Collections.