Definitions

Question 1

Co Payment

Answer 1

A copayment (or copay) is a set amount of money you pay out of pocket when you get a medical service and the insurance covers the remaining amount of the allowed. It’s a way to share costs between you and your insurance.

Question 2

Deductable

Answer 2

A deductible is a set amount of money you must pay out of pocket for covered healthcare services before your health insurance starts to share the costs.

Question 3

Moral Hazard

Answer 3

Moral hazard refers to a situation in which an individual or organization is more likely to take risks because they do not bear the full consequences of their actions. This typically occurs when one party in a transaction is shielded from risk, leading to potentially careless or irresponsible behavior.

Question 4

Prospective Payment

Answer 4

Prospective payments refer to a healthcare payment system where a pre-determined, fixed amount is paid for a specific service, treatment, or care, regardless of the actual cost incurred based on the DRGs the patient falls inot

Question 5

Capitated Contract

Answer 5

Set amount of $, for a set amount of patients, for a set amout of time.

A capitated contract is a payment arrangement in healthcare where a provider is paid a fixed amount per patient for a specific period (usually monthly), regardless of the actual number or cost of services provided to the patient.

Question 6

Co-insurance

Answer 6

Set % amount you pay out of pocket insurance covers the remining %

Co-insurance is a cost-sharing arrangement in health insurance where the patient pays a percentage of the cost of a healthcare service, and the insurance company covers the remaining percentage of the allowed amoung . Co-insurance typically applies after the patient has met their deductible.