The Tricare For Life Claims Processor Discussion Assignment
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The Tricare For Life Claims Processor Discussion Assignment
Plan Recommendations Discussion Replies Assignment
Unit 2 Discussion – Plan Recommendations
99 unread replies.99 replies.
Plan Recommendations
Patients will often look to healthcare providers for information healthcare plans, coverage, and options. Understanding and being able to communicate this information to patients is an important part of working in the healthcare field. Practice making recommendations in this discussion.
There are three patients: Joe, Scott, and Steve. Joe is 42, relatively healthy, and was a member of the Army for 20 years. Scott is 67 and suffers from chronic bronchitis. Steve is 25 and is battling stage 2 cancer.
The Tricare For Life Claims Processor Discussion Assignment
These three patients can choose from one of the following plans (either from Group A or Group B):
Group A Plans: Medicare, TRICARE
Group B Plans: HMO, PPO, and POS
Joe, Scott, and Steve would like recommendations on the best plan options.
Instructions:
Select one patient (Joe, Scott, or Steve) and provide a Group A Plan and a Group B Plan that would be the best options for the provided parameters. Include the following:
A comparison of the two plans
Rationale for selection of the plans
A selection (between the two plans) of what the patient should ultimately choose and why.
Refer to the background material in this unit for assistance and complete outside research as appropriate. Be sure to cite your resources.
Please be sure to validate your opinions and ideas with citations and references in APA format.
Estimated time to complete initial post: 2 hours
This topic is valued at 40 points. Please review post and response expectations. Please review the rubric to ensure that your response meets criteria.
Cite any resources/references in APA formatting that were used in the discussion – if applicable.
Peer Responses/Participation
Due Sunday
The Tricare For Life Claims Processor Discussion Assignment
Continue the conversation regarding patient plan options with classmates through response posts in the discussion board.
Instructions: In your responses to your classmates, include the following:
First response: Select a post where a classmate chose the same patient.
Do you agree with the plan options for the patient? Why or why not?
Do you agree with the final choice? Why or why not?
Additional responses: Select posts where classmates chose different patients.
Do you agree with the plan options for the patient? Why or why not?
Do you agree with the final choice? Why or why not?
Please be sure to validate your opinions and ideas with citations and references in APA format. Estimated time to complete: 1.25 hours x 3 (3.75 hours total)
REPLY TO
Joe is 42 and served for twenty years in the US army and he is relatively healthy. Since Joe served for twenty years that means he will get retirement monthly from the Veterans affairs office for the rest of his life this also includes healthcare he will be able for Tricare select that means his copay is 20% and it covers 80% . Then there is also Tricare for life that is Medicare part A and B combined and Tricare where the patient only pays for plan B and the monthly premium will be based on the individual’s income and Your provider files your claims with Medicare.
Subdiscussion Lucille
MondayMay 11 at 5:37pm
Hello Class,
Steve is 25 and battling stage II cancer and as this type cancer refers to large tumors that grow deep into nearby tissue and determined by many cancer type such as breast cancer, lung cancer or prostate cancer. A person
diagnosed with stage II cancer needs to have a plan that is supported by the cost of therapies and /or surgeries (“What is stage 2 cancer & how is stage 2 cancer treated?,” n.d.). If Group A Plans are selected such as
Medicare, or Tricare, it’s best to also have a medicare supplement as most cancer treatment is covered. Depending on the plan (“Cancer treatment: Medicare supplement plan coverage,” 2019)you choose, your plan may pay
for co-insurance amounts, deductibles and excess charges.
If Group B Plans (“Hmo, PPO, EPO, POS – How do they differ and which should you choose?,” 2013) such as HMO, PPO , and POS were chosen then certain requirements have to be met such as physician, referral, and prior
authorization requirements. These plans also have provider that includes doctor’s, hospitals, and lab that in many cases contacted with a health plan.
Steve, a person with stage II cancer should ultimately choose a plan that fits his / their needs as well as an affordable plan. Group B plans should be chosen for this type of condition because they offer differentiated
services, lower premium payments or cost -sharing plans with fewer restrictions. Although Health Care reform has opened many doors for individual left uninsured, pre-existing conditions are a risk and according to
(Brandes, n.d.) options are now available. Things to consider are out of pocket maximum, premiums, and prescription cost.
References
What is stage 2 cancer & how is stage 2 cancer treated? (n.d.). Retrieved from https://www.cancercenter.com/stage-two-cancer (Links to an external site.)
Cancer treatment: Medicare supplement plan coverage. (2019, October 28). Retrieved from https://www.ehealthmedicare.com/medicare-supplement-articles/can-a-medicare-supplement-plan-help-pay-for-cancer-
treatment/ (Links to an external site.)
Hmo, PPO, EPO, POS – How do they differ and which should you choose? (2013, September 21). Retrieved May 11, 2020, from https://www.verywellhealth.com/hmo-ppo-epo-pos-whats-the-difference-1738615 (Links to an
Brandes, A. (n.d.). I have cancer | Which health plan is best? Retrieved from https://blog.bernardbenefits.com/bid/195551/i-have…
“Medicare pays its portion and sends the claim to the Tricare For Life claims processor.
Tricare For Life then pays the provider directly for Tricare-covered services.” (Military.com,n.d) now compared to an HMO, PPO and POS plans where theirs is a higher co- payments and deductables where part of his retirement from the military he is eligible Tricare is part of the retirement plan provided to him.
Tricare.mil plans healthplans retrieved from https://www.tricare.mil/Plans/HealthPlans/TS (Links to an external site.)
Military.com(n.d)benefits Tricare for life retrieved from https://www.google.com/amp/s/www.military.com/bene…
Group A plan
Underage 65 with specific disabilities or end-stage diseases. (If you have Medicare due to a disability, you can continue your TRICARE Prime enrollment [if you qualify]. If you do, your Prime enrollment fees are waived. You can also get a refund for any Prime enrollment fees that you paid. Check with your regional contractor for details.)
But Group B plan
The Tricare For Life Claims Processor Discussion Assignment
RUBRIC
Excellent Quality
95-100%
Introduction 45-41 points
The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned.
Literature Support
91-84 points
The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned.
Methodology
58-53 points
Content is well-organized with headings for each slide and bulleted lists to group related material as needed. Use of font, color, graphics, effects, etc. to enhance readability and presentation content is excellent. Length requirements of 10 slides/pages or less is met.
Average Score
50-85%
40-38 points
More depth/detail for the background and significance is needed, or the research detail is not clear. No search history information is provided.
83-76 points
Review of relevant theoretical literature is evident, but there is little integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are included. Summary of information presented is included. Conclusion may not contain a biblical integration.
52-49 points
Content is somewhat organized, but no structure is apparent. The use of font, color, graphics, effects, etc. is occasionally detracting to the presentation content. Length requirements may not be met.
Poor Quality
0-45%
37-1 points
The background and/or significance are missing. No search history information is provided.
75-1 points
Review of relevant theoretical literature is evident, but there is no integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are not included in the summary of information presented. Conclusion does not contain a biblical integration.
48-1 points
There is no clear or logical organizational structure. No logical sequence is apparent. The use of font, color, graphics, effects etc. is often detracting to the presentation content. Length requirements may not be met
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