insurances Flashcards
1
Q
fee for service
A
copay/ deductible
insurance reimburses pt. for all or portion of fee
pt. can go anywhere and pay for service
2
Q
HMO
A
copay
pt must go to specific provider (kaiser)
insurance pays pre-determined fixed fee for service
pt. must get a referral
3
Q
PPO
A
any providers BUT has financial incentives for specific ones
insurance pays pre-determined fixed fee for service; pt. pays balance of fee
no referral necessary
4
Q
POS
A
hybrid of HMO and PPO
primary provider serves as gatekeeper to coordinate pt. care
pt. can go outside the network
5
Q
government sponsored plans
A
medicare- people over the age of 65
medicaid- low income
tricare- armed forces
