Block 2 Flashcards
Premium
amount of money paid up front to buy a policy
Cost sharing
deductable
Co-insurance
co-pay
Deductible
amount you have to reach
co-insurance
percentage of payment from insurance company and pt so like 80/20
Co-pay
flat amount paid without a deductible payed first
Annual/yearly out of pocket max
someone is required to pay a certain price then insurance company takes payments over
annual benefit maximum
the insurance company pays then nothing more
lifetime benefit maximum
anthem for 5 years and very expensive baby the insurance company wont pay anymore
Charges on a chargemaster
everything a hospital charges for it is the same regardless of if someone has insurance or not
chargemaster
highest possible level they think they will get paid
Private Pay
out of pocket
as a provider you get what you charge
need to be aware of the market supply and demand
IF you accept government payers what cant you do?
charge different payer sources different amounts
what are charges in healthcare
charges have to be the same for CPT codes however reimbursement can be different
in private pay can you create discounts based on time of service, cash pay
yes charges dont change but most private insurers negotiate a fee schedule
what are the two options for private health insurance?
- employment based- group
- individual based/individual market