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Insurance Fundamenta
| Question | Answer |
|---|---|
| ABN- Advanced beneficiary notice | A form provided to the patient when the provider believes Medicare will probably not pay for a service. |
| Allowed amount | The maximum amount a third-party payer will pay for a particular procedure or service. |
| Copayment | An amount of money that is paid at the time of medical service. |
| Coinsurance | A policy provision frequently found in medical insurance whereby the policyholder and the insurance company share the cost of covered losses in a specific ratio, such as 80/20. |
| Deductable | a specific amount of money a patient must pay out of pocket before insurance will being paying. |
| EOB- Explanation of benefits | A statement from the insurance carrier detailing what was paid, denied or reduced in payment ; also contains information about amounts applied to the deductible, coinsurance, and allowed amounts. |
| PAR- Participating provider | Providers who agree to write off the difference between the amount charged by the provider and the approved fee established by the insurer. |
| generally covers patients who are 65 and older by Part A (hospitalization) or Part B (Routine medical office visits) benefits. | |
| Tricare | Authorizes depends of military personnel to receive treatment from civilian providers at the expense of the Federal Government |
| ChampVa | Covers surviving spouses and dependent children Veterans who died as a result of service-related disabilities. |
| Medicaid | Provides health insurance to the medically indigent population through a cost-sharing program between federal and state governments for those who meet specific eligibility criteria. |
| Managed Care | is an umbrella term for plans that provide health care in return for preset scheduled payments and coordinated care through a defined network of providers and hospitals |
| Workers' compensation | protects wage earners against the loss of wages and the cost of medical care resulting from an occupational accident or disease as long as the employee is not proven negligent. |
| Private insurance plans include | BCBS, Aetna, and United Healthcare. Offer 2 basic plans HMO & PPO. |
| PPO | allows more flexibility in the plan. No need to select a PCP |
| HMO | Health maintenance organization are comprehensive and most plans require their insured choose a PCP |
Created by:
kristiew1
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