The purpose of managed care plans is to provide benefits, such as health care and medical coverage, to members of the plans for reduced costs. Several of the companies that provide managed care health plans are for profit organizations that work with medical facilities and health care providers.
A lot of credit is given to managed care plans for the role they played in holding back the inflation of medical costs in the late 1980s. They were able to accomplish this by decreasing the amount of hospitalizations that were unnecessary, which made providers discount their rates. In turn, this caused the industry of health care to become more competitive and efficient.
By looking over managed care reviews and payment reviews, a person can ensure that they are getting the best coverage possible. Instead of doing business with third party administrators and various insurers, providers have the ability to work with preferred provider organizations.
Having a good network of providers can aid in the negotiation of favorable fees and revenue recovery from providers, the creation of financial incentives for providers, and the selection of providers that are cost effective. Payment reviews can lead to good payment compliance with a provider.
A provider of benefits should be subject to payment reviews. Those receiving benefits, and those acting on behalf of those people, need to be able to keep providers honest.