Ch 9 Insurance and Reimbursement Flashcards
2 main purposes that athletic trainers would utilize for insurance would be
cost-containment or revenue and reimbursement
Premium
amount paid by subscriber for policy
Deductible
amount which subscriber is responsible for paying prior to insurance company taking responsibility for claim or bill
Co-pay
amount paid by the subscriber upon visit to provider prior to receiving services
Co-insurance
applied after the deductible amount has been met by the subscriber in which a percentage of the remaining balance would be distributed between the insurance company and the subscriber
In-network benefets
services provided by preapproved providers w/ whom the insurance company negotiates a fee for that service
Out-of-network benefits
services that are provided outside of the established network of providers; insurance company will still provide payment, although portion payable by subscriber may be greater
Reimbursement-actual charges
insurer will reimburse you for actual cost of specified procedures or services, regardless of how much that cost might be
Reimbursement-percentage of actual charges
insurer pays percentage of actual charges for covered procedures and services, regardless of how much procedures & services cost typical 80%
Indemnity
insurer pays specified amount per day for specified maximum number of days, your reimbursement will never exceed your expenses
Indemnity plan
reimburses subscriber for his/her medical expenses regardless of who provides the service
PPO’s
free choice of HCP, out of pocket cost limited, less coverage for tx provided by nonPPO, more paper work and expenses than HMOs
HMO’s
low out of pocket cost, focus on wellness and preventative care, no lifetime max pay out, tight control make it more difficult to get specialized care, care from nonHMO providers generally not covered
Medicare
federal program provides health insurance to retired individuals
Medicaid
health insurance program for ppl w/ low income
