Managed Care Organizations and Health Insurers are some of the re-known payers. These institutions are referred to as payers because they pay the clinical care providers, the clinical support providers, drugs and device manufacturers for the clinical healthcare services ( Kongstvedt, 2019 ). Amidst other things that they do, making payments is one of the primary things that they undertake in their quest to manage healthcare benefits coverage. However, payers have never paid the different types of medical service providers in the same manner. However, every day, new and even more complex ways to make payments to the providers, though never satisfactory ( Kongstvedt, 2019 ).
On the other hand, provider reimbursement refers to being made whole for absolute out of the pocket expenses incurred on a dollar-to-dollar basis ( Kongstvedt, 2019 ). Unlike provider payment, provider reimbursement works similarly for all people. This, therefore, means that out-of-pocket expenses for a necessity like business travel are reimbursed in the same manner for a company's manager like it is done for a sales trainee ( Kongstvedt, 2019 ). As a result of this balance, provider reimbursement has no influence on the employer's behavior. Still, on the contrary, it makes the employer feel like traveling even more while in his or her job roles since at the back of their minds traveling for the sake of the business does not cost them any money.
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In the United States of America, many private insurance companies negotiate the reimbursement amounts with the medical service providers. One of the problems that the service providers face is in the case of an emergency. Once an emergency has occurred, it is evident that the medical service providers would not ignore such instances as they wait for reimbursement funds ( How healthcare providers are paid by reimbursement , 2020 ). Also, it is not always possible to determine the services' specifics before the entire process is done. As a result, the expenses may overwhelm the expected budget making it difficult to release the reimbursement funds on time and in the amounts quoted.
References
How healthcare providers are paid by reimbursement . (2020). Verywell Health. https://www.verywellhealth.com/reimbursement-2615205
Kongstvedt, P. R. (2019). Health insurance and managed care: what they are and how they work . Jones & Bartlett Publishers.
