Third Party Plans (insurances)

Question 1

co-pay

Answer 1

the portion of the price of the medication that the patient is required to pay

Question 2

deductible

Answer 2

a set amount that must be paid by the patient for each benefit period before the insurer will cover additional expenses

Question 3

formulary

Answer 3

a list of medications covered by insurance plans

Question 4

HMOs

Answer 4

a network of providers for which costs are covered inside but not outside of the network

Question 5

PPOs

Answer 5

a network of providers where costs outside the network may be partially reimbursed and the patient’s primary care physician need not be a member

Question 6

duplicate paid/captured claim

Answer 6

any claim submitted by a physician or provider for the same service/product provided to a particular individual on a perviously submitted claim. The claim should be reviewed and compared to the previous claim, prescriber contacted for any questions, insurance contacted for possible overrides