The first activity in the Ontario Extend MOOC is to identify a concept that is often misunderstood and think of an analogy to help it make sense to students.

In the program that I teach there is no math prerequisite. When I introduce the health-care billing cycle some of my students are quite anxious because they perceive that this is complex math. I use the analogy of going for dinner so that students will recognize that they have done this type of math before.

You go out for dinner and choose from the menu what you would like to eat and the menu lists items and their cost. Once the bill comes, you look it over, you check that the tax percentage is correct, you add in a 20% tip (because your service was awesome!) and you pay the bill. If the bill comes and it is not what you are expecting, you let your server know and together you review the bill. If you find a discrepancy (you did not order two cups of tea) you send it back for correction.

The concepts are the same in health care billing.

Private Bills:

A client sees a provider for a service. The client chooses a service from a list of services (similar to a restaurant menu). If the bill is correct the client pays for the service. If the bill is incorrect, the client seeks out clarification before paying the bill.

Third-Party Insured Services:

The concepts are the same but this time the Insurance Company provides the menu with stipulations to what they will pay. If the Insurance Company sees an extra charge (similar to the extra cup of tea on the restaurant bill) they will send it back to the provider for clarification or correction before paying.

Ontario Health Insurance Plan (OHIP) insured services:

The concepts are similar but this time the provider chooses from the menu and sends the bill to the Ministry of Health and Long-Term Care (MOHLTC). The menu that the MOHLTC provides is the Schedule of Benefits (SOB) a complex menu that lists out the services, the rules, and the fees those providers are paid. If the MOHLTC finds a discrepancy with the bill, they send it back to the provider for clarification or correction before paying.

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