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Insurance Terms vol2

MOP 110 Ms. Ragadio

continuity of care documenting patient care services so that others who treat the patient have a source of information on which to base additional care and treatment.
copayment provision in an insurance policy that requires the policyholder or patient to pay a specified dollar amount to a health care provider for each visit or medical service received.
deductible amount for which the patient is financially responsible before an insurance policy provides coverage.
Fee schedule list of predetermined payments for health care service provided to patients.
Policy holder a person who signs a contract with a health insurance company and who, thus, owns the health insurance policy; the policyholder is the insured, and the policy might include coverage for dependents.
Socialized medicine type of single-payer system in which the government owns and operates health care facilities and providers receive salaries.
third party payer a health insurance company that provides coverage, such as BlueCross BlueShield.
accreditation voluntary process that a health care facility or organization undergoes to demonstrate that it has met standards beyond those required by law.
capitation provider accepts pre-established payments for providing health care services to enrollees over a period of time.
fee for service reimbursement methodology that increases payment if the health care service fees increase, if multiple units of service are provided, or if more expensive services are provided instead of less expensive services.
gag clause prevents providers from discussing all treatment options with patients, whether or not the plan would provide reimbursement for services.
gatekeeper primary care provider for essential health care services at the lowest possible cost, avoiding nonessential care, and referring patients to specialist.
Created by: lolawhiterabbit