→ Chapter 3 → Börja lära dig / Ladda ner MP3 Flashcards

Fråga		Svar
staff model HMO börja lära sig		Physicians are employees of the HMO and paid a salary
Network model börja lära sig		the HMO contracts with at least two groups medical practices described as in network 2
independent practice Association börja lära sig		Marcus the health plan Physicians contract with the IPA to treat members of HMO
preferred provider organization PPO börja lära sig		a delivery Network that manages and negotiate contracts on behalf of the providers
Health maintenance organizations HMO börja lära sig		prepaid health plan
actuary börja lära sig		a professional who calculates insurance and annuity risks premiums and dividends
exclusive provider organizations EPO börja lära sig		delivery Network inwhich patients must use the services of those provided
copay börja lära sig		the out-of-pocket expense you pay the doctor
deductible börja lära sig		the amount of money the insurer paid before the insurance company will pay
subscriber börja lära sig		Blue Cross Blue Shield known as subscribers rather than policyholders
premium börja lära sig		the price paid by the insured for insurance coverage
capitation börja lära sig		payment method under which each patient is entitled to receive a set dollar amount of services in each time period
Usual fee börja lära sig		determined by whether a provider normally charges for that service
customary fee börja lära sig		based on fee charged buy similar providers within geographic area
reasonable fee börja lära sig		any special circumstance of this accident
cobra. consolidated Omnibus budget reconciliation Act börja lära sig		provides that the employee may continue to be insured through employer plan even after being fired. employee picks up total cost
ERISA. Employee Retirement income Security Act börja lära sig		Federal legislation the mandates how employer funded benefit plans must be in administered
coordination of benefits börja lära sig		if a service is covered under more than one policy then the insurance companies determine who pays
third-party payer börja lära sig		insurance company, government, and Managed Care Organization
Prepaid Plan börja lära sig		all types of health plans in which fixed payments are made before services are rendered
pre-authorization börja lära sig		Insurance requires that certain procedures be authorized by the insurer before they are performed. failure will result in denial of claim
gatekeeping börja lära sig		process of restricting access to services
what is the uninsured statistic börja lära sig		45.7 million people or 17% without insurance
Indemnity insurance börja lära sig		one-party is exempt from incurred liabilities by the other party
self-insured börja lära sig		employer pays for Employees Healthcare
third-party admin börja lära sig		companies that manages the paperwork for an employer who establishes a self insured plan
Managed Care börja lära sig		describes the combination of payment for Healthcare and delivery of services into one system
what did Blue Cross Blue Shield originally cover börja lära sig		they prepaid Baylor University 2 hospitalized for 21 days. a group of teachers
what does a self-insuring employer do börja lära sig		the employer pays for Employees Healthcare
what percentage of Americans are covered by some type of insurance börja lära sig		78%

Chapter 3

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