Suzanne is a 72-year-old insured woman who will be admitted to the hospital for a routine hysterectomy.
Suzanne is a 72-year-old insured woman who will be admitted to the hospital for a routine hysterectomy. She is insured based on her age, and her insurance provider has given her and the hospital a list of expected reimbursement amounts for the procedure. What is most likely the type of insurance she has, and does this provider use a prospective or retrospective reimbursement approach? Explain your rationale.
Sample Answer
Suzanne most likely has Medicare insurance. Here’s the reasoning:
- Age: Medicare is a federal health insurance program primarily for individuals aged 65 and over. Suzanne, at 72 years old, falls within the eligible age range.
- Expected Reimbursement: The fact that the insurance provider has provided a list of expected reimbursement amounts for the hysterectomy suggests a pre-determined rate for the procedure. This points towards a prospective reimbursement system.