What do you think? Does this case present an ethical issue? If so, to which party (or parties)? If you could act as the ultimate authority on this situation, what would you do?
PART1: Present the side of the issue that is an ethical issue: please explain the issue and present a solution. (600-800 words)
PART2: Present the side of the issue that is not an ethical issue: please explain why there is no ethical issue and how the industery should present the situation to show patients or interested parties that no ethical dilemma exists. (600-800 words)
Present from the viewpoint of a financial manager, using financial thought process.
Trigon Blue Cross/Blue Shield (Copayments)
When most people are told they owe a coinsurance payment on a medical bill, they simply grimace and write a check; not Gerald Haeckel, a retiree from Richmond, Virginia. He wanted proof that he was not paying more than the 20 percent portion that his health insurance policy required. When his insurer, Trigon Blue Cross/Blue Shield, balked, the retiree besieged state and federal officials with demands for an investigation.
Gerald’s problem with the insurer-provider negotiated discounts began when he became confused by a bill sent by Trigon Blue Cross/Blue Shield. The bill was for Gerald’s wife’s lumpectomy, which is an outpatient surgery to remove a tiny breast tumor. Trigon’s benefits- explanation form stated that the surgery had cost $950, that Trigon paid 80 percent, or $760, and that Gerald owed a 20 percent copayment of $190. But then Gerald received a list of charges from the surgery center indicating that Trigon’s share of the bill had been more than halved to $374 because of a “contractual adjustment.” Gerald assumed that a mistake was made in the surgery center’s statement because if it were correct his $190 copayment would exceed a third of actual cost, instead of the 20 percent called for in his insurance policy.
Ultimately, Gerald’s scrutiny of the $950 surgery bill led to a surprising discovery. Although insurance companies frequently complain about being duped by fraudulent policyholders and providers, Trigon and dozens of other health insurers and managed care companies stand accused of a scheme to siphon off millions of dollars from their policyholders. How does the alleged scheme work? For surgery priced at $1,000, the typical plan might call for the insurer to pay 80 percent, or $800, which leaves the patient with a $200 copayment. But if the insurer has negotiated a 50 percent discount from the provider and does not pass any of it along to its policyholders, the patient’s $200 copayment becomes 40 percent of the $500 actual bill, and the insurer’s portion drops to only $300.
Trigon’s responses to Gerald’s queries stirred up more questions than they answered. Norwood H. Davis, Trigon’s CEO, assured Gerald that he did indeed owe the $190, and added that the details of any Trigon’s provider discounts were “proprietary.” In another letter, Norwood made a distinction between Trigon actually paying its $760 share of the bill and “discharging” it. Norwood added that although Trigon might try to persuade a provider to accept less than its $760 portion of the bill, a policyholder, such as Gerald, was free to try to persuade the provider to accept something less than the required $190 copayment. Gerald, who by that point was incensed, replied “suggesting that an individual policyholder negotiate with a provider for price concessions borders on the insulting!” and he threatened to take the matter up with state regulators.
At a time when consumers are expected to take more responsibility for their own healthcare, undisclosed discounts raise questions about the accuracy and honesty of information provided by the insurers and employers. Indeed, providers often are contractually prohibited from disclosing discounts. The insurance industry argues that hiding discounts is not widespread. The Chicago-based Blue Cross/Shield Association notes that no court has ruled for plaintiffs in a discounts-related case. It adds that none of its affiliates that settled such cases admitted to wrongdoing. Furthermore, Blue Cross/Shield executives argue that the discounts benefit policyholders by reducing premiums. In some situations, they add, employers who share in the savings ask that discounts not be disclosed to their own employees. “We’re not lining our pockets with anything because there is nothing to line our pockets with,” said Joel Gimpel, a Blue Cross/Shield Association attorney.
Why Choose Us
At Myhomeworkwriters.com, we always aim at 100% customer satisfaction. As such, we never compromise o the quality of our homework services. Our homework helpers ensure that they craft each paper carefully to match the requirements of the instruction form.
Professional Academic Writers
With Myhomeworkwriters.com, every student is guaranteed high-quality, professionally written papers. We ensure that we hire individuals with high academic qualifications who can maintain our quality policy. These writers undergo further training to sharpen their writing skills, making them more competent in writing academic papers.
Our company maintains a fair pricing system for all academic writing services to ensure affordability. Our pricing system generates quotations based on the properties of individual papers.
My Homework Writers guarantees all students of swift delivery of papers. We understand that time is an essential factor in the academic world. Therefore, we ensure that we deliver the paper on or before the agreed date to give students ample time for reviewing.
Myhomeworkwriters.com maintains a zero-plagiarism policy in all papers. As such, My Homework Writers professional academic writers ensure that they use the students’ instructions to deliver plagiarism-free papers. We are very keen on avoiding any chance of similarities with previous papers.
Customer Support 24/7
Our customer support works around the clock to provide students with assistance or guidance at any time of the day. Students can always communicate with us through our live chat system or our email and receive instant responses. Feel free to contact us via the Chat window or support email: email@example.com.
Try it now!
How it works?
Follow these simple steps to get your paper done
Place your order
Fill in the order form and provide all details of your assignment.
Proceed with the payment
Choose the payment system that suits you most.
Receive the final file
Once your paper is ready, we will email it to you.
Our Homework Writing Services
My Homework Writers holds a reputation for being a platform that provides high-quality homework writing services. All you need to do is provide us with all the necessary requirements of the paper and wait for quality results.
At My Homework Writers, we have highly qualified academic gurus who will offer great assistance towards completing your essays. Our homework writing service providers are well-versed with all the aspects of developing high-quality and relevant essays.
Admission and Business Papers
With Myhomeworkwriters.com, we will help you secure a position at your desired institution. Our essay writing services include the crafting of admissions papers. We will still help you climb your career ladder by helping you write the official papers that will help you secure a job. We will guide you on how to write an outstanding portfolio or resume.
Editing and Proofreading
Myhomeworkwriters.com has a professional editorial team that will help you organize your paper, paraphrase it, and eliminate any possible mistakes. Also, we will help you check on plagiarism to ensure that your final paper posses quality and originality.
My Homework Writers harbors professional academic writers from diverse academic disciplines. As such, we can develop homework writing services in all academic areas. The simplicity or complexity of the paper does not affect the quality of homework writing services.