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Ch. 12 Reimbursement

Commercial Insurance

QuestionAnswer
Covers the medical expenses of individuals (e.g., private health insurance) and groups (e.g., employer group health insurance. Commercial health insurance
Individual health insurance policies are regulated by individual states and include the following: Fee-for-service High-risk pools Managed care Association health insurance
Group health insurance is available through employers and other organizations, and all or party of the premium costs are paid by whom? Employers
Disability insurance generally does not pay for healthcare services, but provides the disabled person with financial assistance. True
What is the role of a medical adjuster? Reviews healthcare bills submitted to the insurance company for treatment of injuries sustained as the result of a motor vehicle accident to determine coverage.
Reimbursement for income lost as a result of temporary or permanent illness or injury. Disability insurance
When patient are treated for disability diagnoses and other medical problems, separate patient records must be maintained. True
How is a disability claim calculated? Using base pay that usually covers 12 months and is divided into 4 consecutive quarters.
A policy that covers losses to a third party caused by the insured, by an object owned by the insured, or on premises owned by the insured. Liability insurance
Remuneration compensation for pain and suffering
What form is used to file a claim with a liability payer? A regular patient billing statement
Refers to the contractural right of a third-party payer to recover healthcare expenses from a liable party. Subrogation
What does automobile insurance coverage include? Medical payments Personal Injury Protection
Created by: adale3171