Chapter 12: BCBS Flashcards
FSA: Flexible Spending Account
An account that reimburses employees for specified expenses as expenses are incurred.
- funding done through reductions from employees check.
HMO: Health Maintenance Organization
Type of health benefits plan where members are required to receive healthcare from providers in the HMO network only.
- requires PCP referral for majority of services or specialist visits.
HSA: Health Savings Account
An account that reimburses employees for specific healthcare expenses
- Money contributed belongs to you
- Funds may be added by the member, employer, or anyone.
Medicare
Federally funded insurance, typically for those over 65yo.
- BCBS offers and Advantage plan
PPO: Preferred Provider Organization
plan that allows members to choose any provider but offers higher levels of coverage if members receive services from HC providers in that network
HRA: Health Reimbursement Arrangements
An account that reimburses employees for specific HC expenses as expenses are incurred
- Funding provided by employers
Indemnity
AKA Traditional Insurance or Fee-for-Service
- Traditional Insurance plan that reimburses for HC Services provided to members based on providers bills submitted after the services are rendered.
POS: Point of Service
option that allows members to choose medical services as needed & whether they see a provider in or out of network
Medicaid
Joint Fed & estate program that provides hospital and medical expense coverage to low income individuals
Contractual Requirement
BCBS first to use CO.
- for participating providers - they agree to accept the fee schedule set by the contract
What are BCBS Claim Filing requirements?
- Varies from BCBS Plans
- Unless otherwise noted in the contract, timely filing is 1 year from DOS
What is the correct action when a claim has been submitted to BCBS but the provider has not received a response?
Check claim status with the local BCBS Carrier
Which account is usually funded by the employee only and reimburse employees for specified expenses as they are incurred?
FSA
When a provider signs a contract to be a participating provider with an insurance payer they are agreeing to, what?
Accept the fee schedules set by the insurance company
Which type of insurance pan is a federal and state program that provides coverage to the low-income population?
Medicaid
