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pugsrule915
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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
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Traditional Medicare
- Fee for service
- Can see any doctor that accepts Medicare
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Medicare Advantage
- lower copay and deductible
- extra benefits
- have to see physicians in network
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Who are the stockholders?
- Gov
- Priv insurance
- Tax payers
- Health care provider
- Patients
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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
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Modes of paying for health care
- out of pocket
- individual private insurance
- employment-based group private
- gov financing
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Why out of pocket bad?
- need vs luxury
- hard to plan for
- only rely on HCP recommendations
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Experience Rating
Higher risk of problem, higher premium
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Community Rating
Everyone pays the same premiums whether young or old
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Types of Private insurance
- Traditional Fee for Service
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
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Traditional fee for service
- most expensive
- most flexibility when choosing HCPs
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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
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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
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Deductible
Money you pay up to an amount and then insurance pays with you ($3000)
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What are copays for?
Insurance company made to deter you from going somewhere so the doctors also make less money
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Co-insurance
If insurance pay 80% you have to pay the other 20%
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Benefit max
If you cost too much, stop paying
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Premium
Amount you pay each month (part by employer and part by employee
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