|
Home > Preview
The flashcards below were created by user
pugsrule915
on FreezingBlue Flashcards.
-
What is Professionalism
- Behavior that will lead to;
- adherence to ethical practice
- effective interactions with patients
- effective interactions with staff
- reliability, and commitment to improvement
-
Traditional Medicare
- Fee for service
- Can see any doctor that accepts Medicare
-
Medicare Advantage
- lower copay and deductible
- extra benefits
- have to see physicians in network
-
Who are the stockholders?
- Gov
- Priv insurance
- Tax payers
- Health care provider
- Patients
-
Why gov gave 14% more money to Medicare Advantage than directly to health care providers?
If procedure $20, gov have to pay $25. $20 for the procedure and $5 to the private insurance company
-
Modes of paying for health care
- out of pocket
- individual private insurance
- employment-based group private
- gov financing
-
Why out of pocket bad?
- need vs luxury
- hard to plan for
- only rely on HCP recommendations
-
Experience Rating
Higher risk of problem, higher premium
-
Community Rating
Everyone pays the same premiums whether young or old
-
Types of Private insurance
- Traditional Fee for Service
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
-
Traditional fee for service
- most expensive
- most flexibility when choosing HCPs
-
Health Maintenance Organization (HMO)
- lower copay
- cover costs of more preventative services
- few choices of HCPs
- need PCP
- HCP makes choices on surgeries not insurer
-
Preferred Provider Organization (PPO)
- lower copay (like HMO)
- Pay more but get more options
- more choices of HCPs than HMO
- Can go out of network but have to pay more
- dont need PCP
-
Deductible
Money you pay up to an amount and then insurance pays with you ($3000)
-
What are copays for?
Insurance company made to deter you from going somewhere so the doctors also make less money
-
Co-insurance
If insurance pay 80% you have to pay the other 20%
-
Benefit max
If you cost too much, stop paying
-
Premium
Amount you pay each month (part by employer and part by employee
|
|
Get the free mobile app
Take the Quiz
Learn more
Learn more