405_insurance

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Author:
itzlinds
ID:
290614
Filename:
405_insurance
Updated:
2014-12-11 21:10:32
Tags:
405 insurance
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Description:
405 insurance
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  1. the internal/family medicine physician responsible for coordinating the care of his or her pt.
    primary care physican
  2. amount paid by the subscriber for the policy is called:
    premium

    often paid by the employer
  3. the amount the subscriber is responsible for paying prior to the insurance company taking responsibility  for the claim is called:
    deductible

    premium and deductible have an inverse relationship
  4. the amount paid by the subscriber upon visit to the provider prior to receiving services:
    co pay

    some policies limit the total amount of co pay per year
  5. applied after the deductible amount has been met by another subscriber is called:
    co insurance 

    a % of the remaining balance
  6. services provieded by perapproved providers for which the insurance company negotiates a fee for that service
    in network benefits

    cost savings due to lower fees from negotiation
  7. an agreement b/w insurer and a network
  8. allows flexibility for the pt; patient does not need referral for a physican
    PPO
  9. the type of insurance plan in which similar to PPO, but funded by individuals or employer groups, & uniquely arranged from company to company
    HSA  Health Savings Account

    a TAX FREE ACCOUNT
  10. provides health insurance to retired individuals, regardless of their medical conditions, over the age of 65 is
    medicare
  11. joint fed-state program; that mets two eligibility requirements called:
    medicaid
  12. cost containment considerations:

    can be difficult to coordinate due to:
    • timing of injury
    • where the athletes is from
    • type of insurance plan the student carries
  13. list 2 problems with mandating primary insurance:
    • some students do not have insurace
    • some insurance (HMO, PPO) many not cover the athlete at the school
  14. what are the benefits to changing the PCP:
    if possible, change the students PCP to a campus physician; this makes the college resources in network

    some insurances allow exemption for out of network  issues

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