Health Insurance and Managed Care What They Are and How They Work

  • ISBN13:


  • ISBN10:


  • Edition: 5th
  • Format: Paperback
  • Copyright: 2019-02-28
  • Publisher: Jones & Bartlett Learning

Note: Supplemental materials are not guaranteed with Rental or Used book purchases.

Purchase Benefits

  • Free Shipping Icon Free Shipping On Orders Over $35!
    Your order must be $35 or more to qualify for free economy shipping. Bulk sales, PO's, Marketplace items, eBooks and apparel do not qualify for this offer.
  • eCampus.com Logo Get Rewarded for Ordering Your Textbooks! Enroll Now
  • Buyback Icon We Buy This Book Back!
    In-Store Credit: $24.94
    Check/Direct Deposit: $23.75
    PayPal: $23.75
List Price: $88.62 Save up to $54.44
  • Rent Book $50.51
    Add to Cart Free Shipping Icon Free Shipping

    *This item is part of an exclusive publisher rental program and requires an additional convenience fee. This fee will be reflected in the shopping cart.

Supplemental Materials

What is included with this book?


Health Insurance and Managed Care: What They Are and How They Work is a concise introduction to the workings of health insurance and managed care within the American health care system. Written in clear and accessible language, this text offers an historical overview of managed care before walking the reader through the organizational structures, concepts, and practices of the health insurance and managed care industry.
The Fifth Edition is a thorough update that addresses the current status of The Patient Protection and Affordable Care Act (ACA), including political pressures that have been partially successful in implementing changes. This new edition also explores the changes in provider payment models and medical management methodologies that can affect managed care plans and health insurer.
The Fifth Edition also offers new or expanded coverage of:
• “Moral hazard,” and its application in health insurance and managed care
• The ever expanding and evolving payment systems and methodologies used in the U.S. Healthcare System
• The role of benefits design along with discussion about medical necessity and its impact on benefits coverage
• The impact of limitations on sales, governance and administrative (SG&A) costs and profits
• Continued changes in payment mechanisms such as value-based payment under the Medicare Improvement for Patients and Providers Act (MIPPA)
• Medicare Part D, the drug benefit and the plans that offer it, as well as the complexities of Medicare Advantage payment plans, Medicaid expansion under ACA, and more.

Table of Contents

Chapter1 A History of Managed Health Care and Health Insurance in the United States
Chapter2 Health Benefits Coverage, and Types of Health Plans and Payers
Chapter3 The Provider Network
Chapter4 Provider Payment
Chapter5 Utilization Management, Quality Management, and Accreditation
Chapter6 Sales, Governance, and Administration
Chapter7 Medicare Advantage and Medicaid Managed Care
Chapter8 Laws and Regulations in Health Insurance and Managed Care

Rewards Program

Reviews for Health Insurance and Managed Care What They Are and How They Work (9781284152098)