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Self-funded health care, also known as Administrative Services Only (ASO), is a self insurance arrangement in the United States whereby an employer provides health or disability benefits to employees using the company's own funds. [1]
A hospital or provider organization desiring to set up its own health plan will often outsource certain responsibilities to a third-party administrator. For example, an employer may choose to help finance the health care costs of its employees by contracting with a TPA to administer many aspects of a self-funded health care plan.
The department also determines if services and benefits offered by companies are consistent with insurance policy provisions and Ohio law, reviews and approves more than 6,200 company filings per year for life, accident, health, managed care, and property and casualty policy forms and rates. The Director of Insurance, who is appointed by the ...
The idea of self insurance is that by retaining, calculating risks, and paying the resulting claims or losses from captive or on-balance sheet financial provisions, the overall process is cheaper than buying commercial insurance from a commercial insurance company. Cost savings to the self-insured entity are usually realised through the ...
In U.S. health insurance, a preferred provider organization (PPO), sometimes referred to as a participating provider organization or preferred provider option, is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at ...
By 2010, the company was the third largest Medicaid HMO in the country, with $2.5 billion in revenue and 800,000 members across Ohio and Michigan. [12] In 2010, CareSource announced expansion of its provider network in Southeastern Ohio through a partnership with Quality Care Partners (QCP), a physician-hospital organization (PHO). [13]
The biggest factor in the increased number of ER patients was insufficient primary care providers to handle the larger number of insured. [336] Michael Lee Jr. and Michael C. Monuteaux at Boston Children's Hospital analyzed national emergency department visits among children aged 0 to 17 from 2009 to 2016 using the American Community Survey ...
Self-policing by healthcare providers plays a significant role in oversight. Many healthcare organizations voluntarily submit to inspection and certification by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Providers also undergo rigorous testing to obtain board certification, attesting to their expertise.