7) Additional Types of Insurance Flashcards
Individuals with Disabilities Education Act (IDEA)
Law that mandates education for kids w/disabilities who are 3-21y/o
Individualized Education Program (IEP)
Written educational plan for a student w/disabilities
Describe payment for school-based services
- Health insurance is not on the hook
- Payment is through the school or school district through taxes
- Medicaid can cover if student is eligible
What are the exceptions to school-based services coverage and how are these covered?
- Injuries at school
- Sports injuries
- School insurance will supplement student’s health insurance
What does Part C of IDEA support?
Early Intervention (birth-3y/o)
How is early intervention paid for?
Through the child’s individualized family service plan (IFSP)
Name some specialized payers
- Guilds/Unions → Provide care for their members
- Religious Groups
- Fundraising
- Charitable Groups → fund US travel for medical care
- Private organizations
Workers Comp
State-specific liability health insurance for work-related injuries/conditions
- Typically excluded from health insurance coverage
- Some states don’t use CPT codes
- Some states require participation
True or False: There’s multiple ways states to fund workers comp
True
What state are workers comp claims filed in?
The state where the pt got injured
True or False: NJ requires employers to have workers comp or self-insurance or they can get in trouble
True
Describe the workers comp process
- Injured worker files a claim w/their employer
- Claim/case manager reviews and the claim and approves or denies it
- Preauth is typically needed
Is balance billing allowed for workers comp?
Usually not
Automobile Liability
Covers damages to vehicles and individuals involved in a car accident
- Some policies don’t pay for injuries (state-specific)
What happens if a person lives in a no-fault state?
PIP will pay for medical expenses and lost wages for the policyholder and their passengers
- Ensures that peeps can get care no matter who was at fault
