What is a network of managed care?
The network of administered care is a group of doctors, hospitals and other healthcare facilities that concluded a contract for the provision of services to clients of the insurance company at fixed rates. Each insurance company sets the limits of fees and contributions of patients for each specific procedure and all providers in the network agree to these terms. In many countries that do not offer public health care, it is a primary insurance model.
Usually, a contract on major insurance carriers with large percentage of available doctors, specialists, pharmacies, hospitals and other providers in a given area will create an extensive network managed. When the patient is treated, he is immediately charged for his / her benefit and the rest of the bill is sent to the insurance company. The insurance company evaluates the bill, regulates it according to the terms of contracts, sends a notice of coverage of both the healthcare provider, and the patient and pay the approved part of the bill directly to Care.
by the primary feature of the nursing modelThe network is the coding system. Without it, it would be virtually impossible to manage this process. Each procedure is assigned a code and the approved price is loaded into a computer database based on these codes. If the healthcare provider encodes the account incorrectly, it will be delayed and can be completely rejected.
In the network model of managed care, the insurance company also sets the rates of patient contributions. In most cases, visits to the doctor, recipes, visitors and hospital stays are charged to the patient for a flat fee called co-pay. In some cases, this fee may be a flat percentage of the total account instead. Patients may be obliged to select primary care physicians and co-payment for visits to this doctor is usually lower than for specialists visits. Patients may also have a deductible amount that they have to pay for the reward before the insurance begins to cover the expenses.
will often have a nursing network. Preferred or "network" are often providers who have agreed to accept lower service compensation, and the patient's co-patient is generally the lowest for these doctors and equipment. Unpatified or "outside the network" providers either refused to conclude a contract with the insurance company or demanded a significantly higher rate for the services. The use of these providers and services generally includes a higher patient Pay or may not be covered at all. A similar situation exists with prescription drugs.