Posted: December 20th, 2021

Case Study 1 Mrs. Jones, who is 80 years old

Nursing homework help

Case Studies Activity Instructions

Case studies are stories. They present realistic, complex, and contextually rich situations and involve problems to solve and/or questions to answer. Thoroughly read the case studies below and answer the questions presented in each. Your responses to the questions must be detailed and include information supported by academic sources (textbook, .gov, and .edu webistes). Do not use .com, .net, .org, or blog websites. All sources must have been published within the last 5 years.

Please complete all 3 case studies. Your case study responses must follow current APA format and include in-text citations for any resources you use to support your answers. You must also include a separate reference page. The Case Studies Activity must be submitted as a Microsoft Word document.

This assignment is due by 11:59 p.m. (ET) on Monday of Module/Week 2.

Case Study 1

Mrs. Jones, who is 80 years old, presents to ABC Medical Associates today for her annual wellness visit. She was last seen 6 months ago by a doctor in the practice for a bout with influenza.

In today’s visit, the patient will receive her annual gynecological Assessment in addition to a general maintenance examination. She will also have blood work done to evaluate her hypertension, hypothyroid, and type II diabetes.

Mrs. Jones is covered by Medicare and AARP Medigap insurance.

Based on the information in this case study, determine if this is a new or established patient. Then, describe what information you will need to collect from the patient and what steps you must take to ensure the services being rendered will be covered by insurance. Determine which insurance policy is primary.

Case Study 2

Mr. Jones is seen in the ER at Grand Valley Hospital for chest pain. He is from another state and is visiting family. He has never been to Grand Valley Hospital previously.

While in the ER, it is determined that the patient needs a cardiac catheterization done before discharge. This procedure is performed by Dr. Lindsay.

Mr. Jones serves in the National Guard and has been covered by TRICARE since 1989. He is also covered by his employer’s health plan, Blue Cross Blue Shield, and has been covered by this health plan for the past 2 years.

Based on the information in this case study, determine if this is a new or established patient. Then, describe what information you will need to collect from the patient and what steps you must take to ensure the services being rendered will be covered by insurance. Determine which insurance policy is primary.

Case Study 3

Jack Minnow, a 4-year-old boy, presents to Valley Allergy practice because of a recent allergic reaction to a bee sting. He has never had a reaction previously. Jack’s primary care physician Dr. Zane is referring him to Dr. Shelby, an allergist, for a consultation. Jack is accompanied by his mother who is the custodial parent.

During the visit, Dr. Shelby performs a series of allergy tests that identify not only an allergy to bees, but also to animal dander and grass.

Jack is covered by both his mother’s and his father’s employers’ health plans. His parents are divorced. His mother went back to work after the divorce 1 year ago and enrolled Jack under her health plan due to some concerns about whether Jack’s father would keep his job. However, his father is still employed with the same company and has worked there for the past 3 years.

Based upon the information in this case study, determine if this is a new or established patient. Then, describe what information you will need to collect from the patient/guarantor and what steps you must take to ensure the services being rendered will be covered by insurance. Determine which insurance policy is primary.

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Case Study 1:

Based on the information provided, Mrs. Jones is an established patient. She was seen by a doctor in the same practice 6 months ago for a bout with influenza.

To ensure the services being rendered will be covered by insurance, the following information needs to be collected from the patient:

Medicare and AARP Medigap Insurance Details: Obtain the patient’s insurance card to verify the coverage and eligibility. Note the policy numbers, effective dates, and any other relevant information.
To determine which insurance policy is primary, follow these steps:

Medicare is primary for individuals who are 65 years or older. Verify the patient’s Medicare coverage, including Part A (hospital insurance) and Part B (medical insurance). Medicare Part A usually covers hospital and inpatient services, while Part B covers outpatient services and doctor visits.

AARP Medigap Insurance is supplemental insurance that fills the gaps in Medicare coverage. It may act as secondary insurance. Verify the policy details, coverage benefits, and any limitations.

In this case, Medicare would be the primary insurance, and AARP Medigap Insurance would be secondary. However, it is important to confirm this with the patient’s insurance provider to ensure accurate billing and coverage.

Case Study 2:

Based on the information provided, Mr. Jones is a new patient. He has never been to Grand Valley Hospital previously.

To ensure the services being rendered will be covered by insurance, the following information needs to be collected from the patient:

TRICARE Insurance Details: Obtain the patient’s TRICARE insurance information, including the policy number, effective dates, and any other relevant information. TRICARE provides coverage for military personnel, retirees, and their families.

Blue Cross Blue Shield Insurance Details: Obtain the patient’s Blue Cross Blue Shield insurance information, including the policy number, effective dates, and any other relevant information. Blue Cross Blue Shield is the patient’s employer-based health plan.

To determine which insurance policy is primary, follow these steps:

TRICARE is typically the primary insurance for military personnel and their families. Verify the patient’s TRICARE coverage and benefits.

Blue Cross Blue Shield is secondary insurance and may provide additional coverage beyond what TRICARE covers. Verify the policy details, coverage benefits, and any limitations.

In this case, TRICARE would be the primary insurance, and Blue Cross Blue Shield would be secondary. However, it is important to confirm this with the patient’s insurance providers to ensure accurate billing and coverage.

Case Study 3:

Based on the information provided, Jack Minnow is a new patient. He has not previously visited Valley Allergy practice.

To ensure the services being rendered will be covered by insurance, the following information needs to be collected from the patient/guarantor:

Insurance Details: Obtain information about both the mother’s and the father’s employers’ health plans. Collect the insurance cards or policy information, including policy numbers, effective dates, and any other relevant information.
To determine which insurance policy is primary, follow these steps:

Primary Custodial Parent: If the mother has custody and is the primary custodial parent, her insurance plan would typically be the primary insurance.

Employment Status: Determine if the father is still employed with the same company and has continuous coverage for the past 3 years. If he has maintained employment with the company, his insurance may act as secondary.

In this case, the mother’s employer’s health plan would be the primary insurance, and the father’s employer’s health plan would be secondary. However, it is essential to confirm this with both insurance providers to ensure accurate billing and coverage.

Remember to consult the individual insurance plans’ policies and contact the insurance providers directly to confirm coverage and determine primary/secondary status

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