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insurance terms.2

insurance terms part 2

TermDefinition
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 services provided to patients (e.g., a fee is assigned to each CPT code)
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 (or enrollee), 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 (e.g., physicians) receive salaries; the VA health care program is a form of socialized medicine
Third Party Payer A health insurance company that provides coverage, such as BlueCross BlueShield
Accreditation Voluntary process that a health care facility or organization (e.g., hospital or managed care plan) undergoes to demonstrate that is has met standards beyond those required by law
Capitation Provider accepts preestablished payments for providing health care services to enrollees over a period of time (usually one year)
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 (e.g., brand-name vs. generic prescription)
Gag Clause Prevents providers from discussing all treatment options with patients, whether or not he plan would provide reimbursement for services
Gatekeeper primary care provider for essential health care serves at the lowest possible cost, avoiding nonessential care, and referring patients to specialists
Created by: 1berev2