Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:Introduction to Health Care and Public Health in the U.S.
Unit:Financing Health Care - Part 2
Lecture:The Billing Process of Various Health Care Enterprises
Slide content:FFS: Self-pay Self-pay Patient responsible for payment for health care services Uninsured subset of self-pay May seek reimbursement afterwards Self-insured plan: Large employers (ERISA) Costs possibly higher 13
Slide notes:The second form of fee-for-service payment, self-pay, is when patients pay directly for the services they receive. For true self-pay patients, providers may offer a discount. Those without insurance are considered a subset of self-pay, since they are responsible for all expenses. One self-pay scheme involves large employers who self-insure under the Employee Retirement Income Securities Act, or ERISA. With ERISA, t he employer agrees to pay for an employee's medical care. The employer assumes all the risk for the cost of care, and administers and pays for all of an employees health care costs, or in some cases, employees may share some of the costs with the employer. This scheme usually involves a third party administrator, which may be an insurance company, to assist in processing employee claims. Covered individuals may appear to have commercial insurance. As a reimbursement methodology, self-pay costs tend to be higher for services provided than other methodologies. 13