Other Insurances Flashcards
What is Worker’s Compensation?
This insurance provides benefits and wage replacement to employees who need medical care due to a work-related injury.
Who is responsible for reporting the injury to the employer?
The employee/patient. You must have the report of injury.
When should the injury be reported?
The U.S. Department of Labor (DOL) states that sn injury must be reported within 30 days of the incident.
What steps should you take when a WC patient comes in?
- “Confirm” coverage with then employer
- “Obtain” needed information like a case number, date of injury, case worker(adjuster) contact information, and claim mailing address.
- “Create” Create a medical record(account number) and identify it as a WC account.
What is Auto Insurance?
It is a contractual agreement between the policyholder and insurance company that protects the driver /passengers and pays for medical expenses related to the accident.
Who identifies the coverage requirements for auto insurance?
The National Association of Insurance Commissioners(NAIC). Each state develops its own laws while meeting minimum requirements.
What is MedPay?
This is a Medical Expense policy, which offers assistance with medical expenses to the policyholder or passengers no matter who was at fault.
What is Homeowners Insurance?
This covers the policyholder for events that occur to the home or personal property. This insurance will also cover any liability for injuries to the homeowner or others while on the property.
What steps should be taken when a patient provides their Homeowner Insurance?
- “Contact” the Homeowner Insurance
- “Provide” Details of incident, date of injury, and how it occurred.
- “Obtain” Claim number, contact person, and claims mailing address
- “Create” account number and medical record
When are WC, Auto Insurance, and Homeowner Insurance primary?
It is the ONLY insurance billed for incident-related services until the policy limit has been reached.
What is an HMO Insurance?
Health Maintenance Organization is a policy that requires the patient to seek medical services from providers in their “network.” Referrals are required from the primary care provider(PCP) for the patient to see a specialist. This insurance is low-cost with less freedom.
What is a PPO Insurance?
Preferred Provider Organization is a type of plan that allows the patient to seek medical services from any provider who accepts their insurance. It is known as a “preferred” provider because the patient gets to choose their providers. This plan is more expensive with more freedom.
What is Fee-For-Service?
This is when the provider is paid each billable service during an encounter based on medical necessity.
What is Capitation?
This is how HMO plans reimburse providers. This is an agreement with a provider to receive a pre-established payment for health care services to enrollees over a period of time. Reimbursement for patients is the same regardless of how many encounters they have, typically per month.
