→ Chapter 3 → Öğrenmeye Başla / MP3 Flashcards indir

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

Chapter 3

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