How Does Managed Care Affect Health Care Organizations Relationship Essay

How Does Managed Care Affect Health Care Organizations Relationship With Buyers, Sellers, Their Community In General, And the Government - Essay Example This essay declares that managed care plans are government provided health plans based on insurance. They engage in contracts with health care providers or professionals and medical institutions to provide a contracted service to the community. They are the main elements in the network of health care service provision under the federal and state governments system. The managed care plan has a system of rules to determine the amount of insurance money that each enrollee in the plan is entitled. When the service has been rendered by the physician as per agreement, he sends the bill to the insurance company which in turn has the right either to accept it on its face value or to ask for a revised bill. This is where the medical billing and coding companies come to play a role. Next health advocacy groups, i.e. groups of concerned citizens, play a pivotal role by advocating not only the least costly health care but also timely access to it. This paper makes a conclusion that the government’s involvement is seen in the connection between the acceptance and appointment of these insurance companies into the national health care plan, Medicare and Medicaid. While these links are obviously clearer, the relationship between the MHO and the patient is determined by the rules of the insurance plan. The former pays what the latter is entitled to under the plan, though there is no hard and fast rule to prevent a patient from seeking more expensive care outside the plan.