Managed Care Plan Enrollment, Essay Example

What should the ABC Insurance Company do? Why? How?

The ABC Insurance Company should have never included the XYZ Hospital under their strict regulations and demands.  This would have clearly upset many employers that would not have purchased the ABC insurance policy for their employees; however, the ABC Insurance Company would have done well to focus on a specific area of the 14 counties that did not involve such a large land mass.  This included the additional problems of patients that could only go to the XYZ Hospital and some were forced to drive an additional 50 miles to receive health care and not be completely covered if they needed emergency care by a closer hospital.  The overall goal of providing health care and health insurance should be that the customers are able to receive health care when they need it without jumping through hoops to do so.

To resolve this problem, the ABC Insurance Company should look to buy out the binding contract or come to terms for an agreement to dismiss the document if this is at all possible.  Again, this would upset some of the employers in the 14-county areas around Atlanta, but it would also allow for individuals to receive the immediate health care they need when they need it.  The ABC Insurance Company should look to draw up a new plan that encompasses those counties and employers that want to have the XYZ Hospital as the sole provider.  This is more likely to include employers that are closer to the XYZ Hospital so there would not be the large travel or availability issues that many patients would face when trying to receive the care they need.  If separate plans can be developed and agreed upon, it could go a long way to allowing for the employees to receive the appropriate health care they need, while continuing the high profits that the ABC Insurance Company has been receiving in its early successes so far.

What should XZY Hospital do? Why?

The existing staff physicians at the XYZ Hospital objected to losing available hospital space and time, including the possibility of losing existing patients to the new physicians of the ABC Insurance Company’s plan.  These physicians threatened to dis-enroll from the plan.  The concerns they brought up are very legitimate and would ultimately lower the quality of health care that the hospital and the physicians could provide to the Atlanta population.  In order for these problems to be reduced, the XYZ Hospital should look to renegotiate the original plan.  The success that ABC Insurance had with selling the plan to employers around the 14 counties was excellent, but it was too much for only one hospital to be the sole provider.  The hospital may not be willing to allow other hospitals and physicians the right to treat patients under this plan, or it will continue to risk being understaffed and improperly qualified to handle such a large patient volume.

What should the employers do? Why? How?

The employers should first listen to any complaints that may come up from their employees.  This plan is likely to upset many of the employees, but the employer may not need to change the plan immediately if there is not an immediate need.  However, it is likely that with the added travel and specific limitation of physicians that can provide treatment, there will be an outcry by many of the employees.  The employers should then go back to ABC Insurance Company and seek to renegotiate the insurance plan or get out of the agreement as quickly as possible and seek additional coverage from another company.  The contract that ABC has with the XYZ Hospital looks good on paper because of the high quality of care, and many of the employers should promote this factor with the employees; however, the employers only asked that XYZ was included in the package, not that it was to be the sole provider.  Many insurance company contracts are bound by law, so the employer will have to wait until the contract runs out before they can seek additional coverage from another company.

What should the patients do? Why? How?

The patients should complain to their employers as soon as possible regarding the forceful nature of the new insurance plan. The employers have basically signed up for a plan that requires that only specific physicians and the XYZ Hospital can provide them health care.  Emergency Room visits are almost out of the question, and many of the employees will not be able to see the physicians that they are usually seeing for health concerns and treatment.  In addition, they may need to travel up to 50 miles receive their treatment now.  The patients must file complaints with the employer, the human resources department, the insurance company, and the local union, if one exists.  However, apart from filing complaints and demanding change there is very little that can be done by the patients to change the existing plan unless they purchase a plan on their own from an external party not associated with ABC Insurance.