→ Chapter 3 → Rozpocznij Naukę / Ściągnij Fiszki MP3

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

Chapter 3

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