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2
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100
amount of money the policyholder pays per claim or per accident toward the total amount of an insured loss before the company will pay on the claim
What is deductible
100
these plans require healthcare providers to become participating providers
What is all government sponsored health plans and Indemnity health insurance plans
100
This HMO model hires physicians and pays them a salary rather than contracting the physicians to create a network
What is Staff Model
100
entities that make payment on an obligation or debt but are not parties of the contract that created the debt
What is third party payers
100
organizations that fund their own insurance programs offer their employees
What is self funded plans
200
health insurance benefits are determined by
What is indemnity schedules, service benefit plans, relative value studies
200
the difference between medicare reimbursement and patient financial responsibility
What is Medigap
200
This referral can be approved online when it is submitted through the providers Web Portal to the utilization review department
What is STAT referral
200
maximum amount of money third party payers will pay for specific procedure or service
What is allowable amount
200
amount of money paid to keep an insurance policy in force
What is premium
300
protects workers from loss of wages after an industrial accident that happened on the job
What is Workers compensation
300
todays health insurance policies cover
What is preventative care and procedures deemed medically necessary
300
these managed care plans require preauthorization for medical services such as surgery
What is HMO, PPO EPO
300
federal and state sponsored health insurance program for the medically indigent
What is Medicaid
300
amount payable by an insurance company for a monetary loss to an individual insured by that company, under each coverage
What is benefits
400
this part of medicare covers prescription drug services
What is D
400
this type of referral is processed immediately
What is STAT
400
This is not reviewed by a utilization review committee
What is fees for services provided
400
physicians who enters into a contract with an insurance company and agrees to certain rules and regulations
What is participating provider
400
Childrens Health Insurance Program
What is CHIP
500
this expense would be paid my Medicare Part B
What is physicians office visit
500
the Tricare option that is similar to a preferred provider network
What is TRICARE Extra
500
Under which of the following Medicare plans for primary care and specialists is the pt required to pay a monthly premium
What is Medicare Part B
500
review of individual cases by a committee to make sure that services are medically necessary and to study how providers use medical care resources
What is utilization review
500
low income medicare pts who qualify for Medicaid for their secondary insurance
What is QMB
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