Test 1- Insurance Flashcards
What is the purpose of a co insurance?
For the insurance company to pay a partial percent and patient responsible for remaining percent
What is the main idea behind an EOB?
To prevent fraud
The medical provider can receive benefits in which way?
Assignment of benefits (AOB)
If someone’s spouse is the primary on an insurance that makes the spouse what in the policy?
Policy holder
If Mr. clock has to pay $2,500 for his insurance to effectively work, this is called what?
Deductible
If a child’s parents both have insurance how is it determined which insurance is billed first?
The birthday rule, whichever policyholders birthday in the calendar year comes first is used
What is a remit?
A summary paid to a provider within a particular time.
The proper definition of healthcare insurance is?
A contract between an individual policy holder and a third party or government program
If a procedure is not covered by the insurance is there anyway that the procedure can be approved?
Yes, using pre authorization
Exclusions
When children are removed from their parents insurance
Procedures not covered by the insurance policy
At what age does a child no longer become eligible to be on their parent’s insurance?
26
What is the definition of COB? When is it used
Coordination of benefits- when you have more than 1 insurance policy. You can use both to pay for procedures
Ex: a child can use both parents insurance
Spouses can use both insurance
What is a copayment? How does it work?
A payment that is made in order to cover a portion of the admin fee
It’s collected at the time of service
What is MCO
Managed Care Organization
How many MCO’s are there?
6
