→ Chapter 3 → Začnite sa učiť / Stiahnite si MP3 Flashcards

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

Chapter 3

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