→ Chapter 3 → Sāciet mācīties / Lejupielādēt MP3 flashcards

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

Chapter 3

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