Chapter 17: Insurance and Billing
Health insurance is a written contract in the form of a policy between the policyholder and a health plan. Health insurance helps cover costs associated with medical care, such as doctor visits, hospital stays, and prescription drugs (benefits). Fee-for-Service / Managed Care: HMO, PPO Government Sponsored Plans
Understanding Health Insurance
Physicians are required to sign a contract with insurance carriers in order to participate in their networks and provide services to their members. In some cases, physicians can negotiate their contract with insurance carriers in order to secure better reimbursement rates. Fee schedule: A list of usual fees for procedures and services frequently performed. Allowed Charges: The maximum amount the payer will pay any provider for each procedure or service.
Did you know?
The Affordable Care Act (Obamacare) requires health insurance plans to cover at least 10 essential health benefits, such as emergency services, hospitalization, and prescription drugs. The Affordable Care Act (ACA) allows you to appeal insurance decisions made by health insurance companies related to coverage and payment. The ACA requires employers with more than 50 full-time employees to offer health insurance coverage or face a penalty.
Did you know?
The Affordable Care Act (ACA) was originally created to be a bipartisan effort. The ACA was the first law in the US to make it illegal for health insurers to deny coverage due to pre-existing conditions. The ACA also expanded Medicaid coverage to adults with incomes below 138% of the federal poverty level. Under Obamacare, young adults are allowed to stay on their parents’ health insurance up to age 26.
Did you know?
What is the purpose of health insurance?
- To help cover medical expenses
- To provide free medical care
- To prevent illness from occurring
Draw a dancing dinosaur wearing bunny slippers
What does HMO stand for?
- Health Maintenance Organization
- Home Medical Officer
- Hospice Medical Organization
What does PPO stand for?
- Preferred Provider Organization
- Preferred Physician Organization
- Personal Prerogative Option
What is a premium in regards to health insurance?
- The amount paid for coverage
- A type of policy
- The amount paid out-of-pocket for medical expenses
What are the key differences between an HMO and a PPO health insurance plan?
Which type of plan typically offers the GREATEST flexibility in choosing healthcare providers?
- PPO (Preferred Provider Organization)
- FFS (Fee-for-Service)
- HMO (Health Maintenance Organization)
What is a deductible in regards to health insurance?
- The amount you pay before your insurance kicks in.
- A type of medical procedure.
- A form you fill out when visiting the doctor.