[Answered]: Real-World Scenario 5.2 Mrs

Real-World Scenario 5.2 Mrs. Thomas was on vacation out of state, stepped off a curve, and sustained a left ankle injury. Due to severe pain, Mrs. Thomas was seen at an urgent care center where a left ankle x-ray was performed, which was negative. Mrs. Thomas was diagnosed with a left sprained ankle. A walking boot was provided to stabilize and protect the left ankle. Mrs. Thomas was provided with appropriate discharge instructions and instructed to follow up with the primary care physician upon returning home. When presenting the BlueCross BlueShield insurance card at check out, Mrs. Thomas was informed that the physician who provided treatment is a nonparticipating provider (nonPAR) and that the urgent care center accepts credit cards for payment in full. The total due was $1,500, and Mrs. Thomas assured the office staff that the insurance company would reimburse the urgent care center for services provided. The office staff further explained that their providers had not signed a contract with that insurance, and thus, Mrs. Thomas was required to settle the bill upon discharge. The office staff suggested that the Blue Cross/Blue Shield insurance plan might reimburse Mrs. Thomas for the urgent care center encounter. Mrs. Thomas would need to submit the invoice and claim to the insurance company. Questions Answer the following questions in your 100 word essay about the above Real-World Scenario 5.2: 1. Did the urgent care center’s office staff correctly describe their nonparticipating provider (nonPAR) status to Mrs. Thomas? Explain. 2. What are the requirements of a BCBS participating provider (PAR)? 3. What does BCBS agree to do for participating providers (PARs)?