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Med. Insurance Terms

Medical Insurance in a Flash Chapter 10

QuestionAnswer
Primary care physician who polices the referrals for additional tests andconsultations by other physicians Gatekeeper
The process used to ensure that healthcare is used appropriately and not wasted Utilization
PPO Prferred provider organization
The largest HMO in existence today Kaiser Permanente
HMO Health maintenance organization
The percentage of insurance providers that offer some type of managed care plans 95%
Form used for approval of test or procedures Preauthorization form
Afixed per capita method of payment by managed care plans Capitation
Form obtained from gatekeeper used to authorize tests or services from another provider Referral form
POS Point of service plan
Popular Insurance sets

 

 



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