Mrs. Thomas was on vacation out of state when she stepped off a curve and injured her left ankle. Due to severe pain she was seen at an urgent care center where she underwent a left ankle x-ray, which was negative. She was diagnosed with a left sprained ankle. A walking boot was provided to stabilize and protect her left ankle. She was provided with appropriate discharge instructions and instructed to follow up with her primary care physician upon returning home.
When she presented her 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 her 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 her insurance, and thus Mrs. Thomas was required to settle the bill upon discharge. The office staff suggested that her Blue Cross/Blue Shield insurance plan might reimburse Mrs. Thomas for the urgent care center encounter and that she would need to submit the invoice and claim to her insurance company.
What does BCBS agree to do for participating providers (PARs)?
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- Ms. M is 42 years old and has had rheumatoid arthritis for six years. At baseline, her fingers are stiff and show slight ulnar deviation. She has come to see you as she is currently experiencing an exacerbation, and her wrists are red and swollen. She finds it to be painful when something such as clothing touches the skin over her wrists. Her elbows and knees are also stiff and painful, especially after she has been resting. She is feeling extremely tired and depressed and has not been eating well. Describe the pathophysiologic process that leads to the appearance and the pain occurring at her wrists. Is this an acute or chronic process? Could it be both? Describe the pathophysiology contributing to the stiff, deformed fingers. What terms can be used to describe this?arrow_forwardAn older adult female client has osteoporosis. In counseling the client about the best form of exercise, the nurse would recommend which of the following? Question 25 options: a) Cycling on a stationary bicyle b) Walking c) Jogging d) Swimmingarrow_forwardMrs. Lin is 85 and very weak. She needs assistance to get out of bed, stand up, and walk. You are assigned to assist her to ambulate in the hall using a walker. As you walk down the hall, Mrs. Lin tells you she feels weak and faint. She loses her balance and begins to fall. Answer these questions to help you understand your role in assisting the client in ambulation. What assessments were made when she first sat on the edge of the bed? What preventive measures did you do before ambulating Mrs. Lin? As the support worker, what did you do when Mrs. Lin lost her balance? What techniques did you use to prevent injury to Mrs. Lin or yourself?arrow_forward
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