Wednesday - Insurance And Law Flashcards
Primary insurance
Insurance plan responsible for paying health coverage FIRST
Secondary Insurance
The insurance plan that is billed after the primary plan has paid its contracted amount
Tertiary insurance
Insurance coverage in addition to primary and secondary which covers gaps in the first two coverages
Define coinsurance
The % of the allowed amount the patient will pay once the deductible is met
Define copayment
A set amount determined by the insurance plan that the patient pays for specific services usually office visits
Define deductible
The amount that must be paid before benefits are paid by the insurance company
What is apart of HMO plan
Lower out of pocket cost
Fixed annual fee
Stays in network besides ER
What is apart of PPO plan
Higher out of pocket cost
Multiple providers
Can receive special services without referrals, pre certification, or pre authorization
What is a pre certification with insurance
A request to determine if a service is covered by the patients policy
What is a pre authorization with insurance
Formal approval from the insurance company that it will cover the test or procedures
Define Medicare
It is federal
For patients 65+
Disability
Renal disease (end of life)
Define Medigap
Coverage that picks up where Medicare coverage leaves off
Define Medicaid
It is within State
For families, children, pregnancy
Limited income
*an individual can qualify for both Medicaid and Medicare and it is considered “Medi-Medi”
Medicare Part A Covers…
Hospital Coverage
Medicare Part B covers…
Outpatient and professional care
