Reference no: EM132443116

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.

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 evaluation 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.

1. 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.

1. 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.

1. 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.