Impacts of insurance plans on patient care practices

Sample Question

How do insurance plans/payors (Medicare, Medicaid, HMOs, ACOs, ACA) impact your current patient care practices? In the spirit of patient advocate, what questions would you like answered by the insurance plans/payors regarding billing practices, etc?

Sample Answer

One of the major concerns of American population is the access to affordable care.  Although the enactment of Affordable Care Act was premised on increasing accessibility of healthcare by reducing the cost, the calls for its repeal have left a significant number of health consumers uncertain about its future. Nonetheless, insurance plans have various effects on the current patient care practices. One of the impacts is the billing systems. Healthcare consumers are poorly served because providers do not understand the billing practices offered in the various insurance plans.

The health insurance plans have different conditions, resulting to limitations in health coverage (Brill, 2013). As a result health consumers are poorly informed about the extent at which their insurance covers the medical costs. The lack of awareness regarding the billing system is compounded by the exorbitant charges by healthcare facilities, on drugs, medical procedures and equipment above the existing market prices for the healthcare services and products. This raises questions regarding what extent of medical bills is covered by the insurance. Additionally, the medical insurers are not legally compelled to explain clearly to health consumers about their health policies. 

As a patient advocate the questions that would like answered by the insurance plans regarding billing practices include”   What are the specific health plans do you offer? What is the percentage of the medical cost does the plan cover?   With managed care such as HMO or PPO, what is the percentage or minimal amount of    healthcare expenses should a patient pay out of pocket?  Another question is “Do you have limitations on the choice of physicians and healthcare institutions that a patients attend?


Brill, S. (20 February, 2013). Bitter Pill: Why Medical Bills Are Killing Us. How outrageous   pricing and egregious profits are destroying our health care.  Retrieved from[2/26/2013/