contract that provides money to cover all or a portion of the cost of medically necessary care

health maintaince organization

aka HMO managed care organization that provides low cost health care for its members in exchange for stringent guidelines and a limited choice of providers

paitents annual financial responsibillity that must be met before the health care plan begins paying for health care costs

a health care professional who provides services to individuals covered by a particular health insurance policy & who Accepts the insurace companies approved fee for each service aka participating provider

does not contract with insurance companies aka non - participating provider

independant practice assocation

4 models of HMO contracts directly w/ physicans who practice in their private offices

managed care organization

any method of organizating health care providers that provides acess to high- quality , low cost care

maximun allowable fee

$ ammount typically considered payment-in-full by an insurance company &an assocated network of health care providers.aka allowed charge

owner of the health insurance policy

prefferred provider organization (PPO)

contract w/ private payers to provide care to the helth plans members

physicians & provifers who accept the benefit paid by the insurance company for a specific service as payment in full of that service ; the patient does not have to pay any difference

assignment of benefits

authorization given by the patient that identifies who accually recivies the insurance payment

health insurance palns that allow members to choose their health care providers

reimbursement method that depends on the # of individualas covered by the health insuracne contract , used to pay primary care physicans

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vocab 9-29

Term	Definition
health insurance	contract that provides money to cover all or a portion of the cost of medically necessary care
health maintaince organization	aka HMO managed care organization that provides low cost health care for its members in exchange for stringent guidelines and a limited choice of providers
deductible	paitents annual financial responsibillity that must be met before the health care plan begins paying for health care costs
in-nerwork provider	a health care professional who provides services to individuals covered by a particular health insurance policy & who Accepts the insurace companies approved fee for each service aka participating provider
out-of network	does not contract with insurance companies aka non - participating provider
independant practice assocation	4 models of HMO contracts directly w/ physicans who practice in their private offices
managed care organization	any method of organizating health care providers that provides acess to high- quality , low cost care
maximun allowable fee	$ ammount typically considered payment-in-full by an insurance company &an assocated network of health care providers.aka allowed charge
policy holder	owner of the health insurance policy
prefferred provider organization (PPO)	contract w/ private payers to provide care to the helth plans members
accept assignments	physicians & provifers who accept the benefit paid by the insurance company for a specific service as payment in full of that service ; the patient does not have to pay any difference
assignment of benefits	authorization given by the patient that identifies who accually recivies the insurance payment
free for service	health insurance palns that allow members to choose their health care providers
capitation	reimbursement method that depends on the # of individualas covered by the health insuracne contract , used to pay primary care physicans

Created by: ashlyn.shaw

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