Heal me, Help me
Expert on Hormones and metabolism. I can treat conditions like diabetes, Thyroid problems, Calcium and Bone disorder
Endocrinologist
Graduates of Family Practice, Internal Medicine or Osteopathy. It determines the Medical necessity for specialist care or hospitalization. They are also called as gate keeper
Primary care provider or PCP
Health insurance companies classify providers as:
Participating(PAR) AKA In network (INN)
NON- Participating (NON-PAR) AKA Out of Network
It is a Federal funded plan
Medicare
The amount of money that the customer pay to the insurer periodically for health insurance coverage.
Premium
A doctor who treat Kidney disease
Nephrologist
Gave at least 3 Type of Facilities Commonly found in the US
Ambulatory, Birthing Centers, Blood banks, Clinic Medical offices, Dialysis Centers, Hospice Homes, Hospitals, Imaging/Radiology centers, Diagnostic laboratories, Nursing Homes, Mental Health & Addiction Treatment Centers, Orthopedic & other Rehab Centers, Urgent Care, and Telehealth
This is a type of MCP Plan that only provides INN Coverage and requires a gatekeeper who needs to initiate a referral from the insurance company
HMO (Health Maintenance Organization)
The plan is purchased by the members for themselves and their dependents.
Individual Sponsored Plan
A package of healthcare services that a health insurance company covers for members of a specific health insurance plan.
Benefit
A cancer specialist
Oncologist
These are services given to a patient whose condition needs immediate attention but not life threatening.
Urgent Care
This is a type of MCP Plan that provides INN and OON coverage. It does not require a PCP or Referral to see a specialist
PPO ( Preferred Provider Organization)
A Classification of health insurance that is Funded by either the Federal or State Government to support certain eligible people
Federal/State funded Plan
ex: Medicare or Medicaid
It Consist of Copay, Deductible and Coinsurance
Out of Pocket expenses
A specialist for problem like lung cancer, Pneumonia, asthma, emphysema and trouble caused by breathing issues
Pulmonologist
A type or service that focus on Rehabilitation therapies are aimed at helping patients recuperate from a variety of injuries and illnesses.
PT/OT/ST or Chiro
Physical Therapy, Occupational Therapy, Speech Therapy and Chiropractic service.
This is a type of MCP Plan that only covers INN providers but not requiring to elect a PCP or Referral.
EPO - Exclusive Provider Organization
Plans that are purchased by an employer or group from a private insurance company for their employees and their dependents.
Employer or Group Sponsored Plans
Is the general term used by the insurance company to address its customers or policy holders.
Specialize in dealing problems with urinary tract system for both Men and Women
Urologist
A facility or program that is created to provide a nurturing environment for meeting the physical and emotional needs of a terminally ill patient
Hospice
This is a type of MCP Plan that Covers INN and OON Provider but requires a PCP referral to se an INN specialist, However it does not require a referral to see an OON specialist.
POS- Point of service
What are the two common concept of insurance
Traditional and Manage Care
An individual, entity or organization who provides any form of medical treatment to a patient.
Provider