How to Answer Payers Contracted With Questions (Complete Guide)

This question tests key academic concepts commonly covered in coursework.

What This Question Is About

This question relates to payers contracted with and requires a structured academic response.

How to Approach This Question

Start by identifying the main issue, then apply relevant academic frameworks.

Key Explanation

This topic involves payers contracted with. A strong answer should include explanation, application, and examples.

Original Question

ll payers are contracted with both you and your competitor, and the 1,000 physicians. The payer contract requires that all physicians steer their patients to equitable facilities for surgeries. All plans sold by the payers do offer out of network benefits. Example: In network benefit covers 90% of the contracted rate, plus coinsurance and deductible Out of network benefits cover 60% of billed rates, but not to exceed a reasonable and customary rate For a Given Service: The billed amount at your hospital is $1,500 for the facility The contracted rate is $900 Reasonable and customary is $750 The physician surgical fees are $300 The contracted rate is $175 Reasonable and customary is $155 The freestanding surgery center charges a global fee (facility & physician) of $1,200 The reasonable and customary is $800 Uninsured patients pay 10% of Reasonable and Customary What is the best reason why a patient would not want to access services at the freestanding surgery center? A. Their employer switched to a high deductible health plan B. Their health plan no longer offers out of network benefits C. They prefer to access services at a hospital D. They are not happy with their physician

******CLICK ORDER NOW BELOW AND OUR WRITERS WILL WRITE AN ANSWER TO THIS ASSIGNMENT OR ANY OTHER ASSIGNMENT, DISCUSSION, ESSAY, HOMEWORK OR QUESTION YOU MAY HAVE. OUR PAPERS ARE PLAGIARISM FREE*******."