Description

In this episode of Only Healthcare, we dive into the complexities of the commercial insurance landscape, particularly focusing on how employer decisions shape health benefits coverage and reimbursement processes. The conversation does not touch on entitlement programs but rather hones in on the intricacies of commercial health insurance and its impact on both employers and employees.

Key Topics Discussed:
1. Coverage:

• Definition and Legal Framework: We explore the legal right to receive reimbursement or payment for healthcare costs under a contract with an insurance company, a group health plan, or government programs like Medicare.
• Difference Between Coverage and Policy: Learn about the nuances between insurance coverage and policy, including how a typical insurance policy is a collection of coverages with distinct limits.

2. Reimbursement:

• Understanding Healthcare Reimbursement: The episode clarifies how payments are made to healthcare providers, hospitals, or pharmacies after services are rendered. We discuss how the amount billed is based on pre-agreed terms with health insurance companies, PBMs, or Medicare.
• Types of Insurance and Reimbursement: Discover the concept of Health Reimbursement Arrangements (HRAs), a non-traditional type of insurance allowing employers to provide non-taxed reimbursements for eligible medical expenses.

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Sponsored by:
Peek: A game-changing prescription shopping solution that allows its members to view all their prescription cost options across cash discount programs and their insurance in one easy-to-use platform. Peek is currently being offered to organizations to help both employees and plan sponsors save money on their prescription spend. https://peekmeds.com/.

Institute for Integrated Health (IIH): Health care benefits, insurance coverage regulations, and doing business in the healthcare industry can be complicated. At IIH, Dr. Randy Vogenberg and his team understand these unique challenges and provides strategic guidance customized to every client. To help overcome your unique challenges, IIH delivers education, planning and advisory on market trends, and U.S. health care market intelligence. The firm’s decades of proven success are due to strategic collaboration with associates from the business, clinical, and scientific communities. https://iih-online.com/.