Insurance Systems
Type of insurance that the patient purchases in the form of a policy from health insurance company for purpose of covering medically related expenses
Medical insurance
Medical or accidental insurance that begins to pay for covered medical expenses as soon as the institution pays the deductible
Primary coverage
Must use primary care provider that participates in this type of third-party pay, provides fixed fee for services
Health maintenance organizations (HMOs)
A list of codes published by the American Medical Association that represents the vast majority of medical procedures.
Current Procedural Terminology (CPT)
Intended to supplement student's family insurance plan and reimburses the cost of athletic accidents only
Athletic accident insurance
Policy that pays for covered medical expenses only after all other insurance policies, including the athlete's personal medical insurance, have reached their limit
Secondary coverage
Assigns primary care physicians who act as gatekeepers by coordinating patient care, similar to preferred provider organizations
Point-of-service plan (POS)
On what day and year were the CPT codes revised? January 1st, 2017
January 1st, 2017
More comprehensive because it includes more provisions for maintaining good health rather than just illnesses and injuries
Health insurance
One reason for purchasing primary insurance coverage
Sense of responsibility for paying all medical expenses, large percentage of uninsured student-athletes, or simplified and accelerated claims processing
Provide group and individual coverage for employees and their dependents and follows fee-for-service plan; free to go to any medical provider
Private medical insurance
Condition that the ICD code 845 stands for
Sprains and strains of the foot and ankle
Designed to protect athletes against future loss of earnings because of a disabling injury or sickness that occurred during sport
Disability insurance
One advantage of self-insurance
Potential savings, simplified claims process, greater flexibility
Government-sponsored programs that provide coverage for elderly (answer 1) and needy (answer 2)
Medicare and Medicaid
The percentage of a medical bill not paid by the insurance company and that the patient is responsible for
Copayment
Provides lifetime medical, rehab, and disability coverage for athletes who suffered long-term disability from injury
Catastrophic insurance
One disadvantage of self-insurance
High risk for large claims, risk of bankrupting fund, or institutional dollars tied up
Allow a greater choice of health care providers than HMOs and pay medical vendors on a fee-for-service rather than capitated basis
Preferred provider organizations (PPOs)
Method using different insurance companies to underwrite different levels of coverage in a common policy
Layered coverage