Definitions of Insurances
This type of insurance is a managed care health insurance plan that provides comprehensive medical coverage through a network of providers.
What is an HMO? - Health Maintenance Organization
This Part covers provider visits and outpatient services.
What is Part B?
Medi-Cal is funded by these two entities.
What are the federal government and the state of California?
PPOs offer coverage for these types of providers, though at a higher cost.
What are out-of-network providers?
This is what HMO stands for.
What is a Health Maintenance Organization?
This type of insurance provides coverage through a network of contracted doctors, hospitals, and other healthcare providers that allows patients to have flexibility to see any provider.
What is a PPO? - Preferred Provider Organization
This is the terminology for an annual physical exam for a patient with Medicare A & B insurance.
What is a Medicare Wellness Visit (MWV)?
This term describes when Medi-Cal members get care through a specific health plan that organizes their services.
What is a managed Medi-Cal plan?
Both PPOs and EPOs do not require this to see a specialist.
What is a referral?
HMO Members must receive care from providers in this
What is the network?
This type of insurance is a public health insurance program jointly funded by the federal and state governments providing fee/low-cost health coverage to eligible individuals.
What is Medi-Cal (Medicaid)?
True or False: If a patient insists on scheduling an HME vs an MWV, we are allowed to schedule after advising them that Straight Medicare does not cover and they may have financial responsibility.
What is True?
True or False: Sutter Primary Care does not see patients with managed Medi-Cal plans.
This hybrid plan combines features of HMOs and PPOs.
What is POS Plan? (Point of Service)
True or False: HMOs usually require referrals to see specialist.
What is True?
This type of insurance is a federal health insurance program in the U.S for people aged 65 or older and/or for younger individuals with certain disabilities or conditions.
What is Medicare A & B?
This is what a MWV covers.
What is Height/Weight measurements, Blood pressure, BMI Calculations, Vision test, and Assessment of safety?
When scheduling a patient as self-pay when they have a non-contracted Medi-Cal health plan it can lead to this risk.
What is risk of losing/disrupting of policy?
This type of plan requires you to use in network providers for coverage except for emergencies at a lower premium than a PPO.
What is an EPO?
HMOs often use this method to control cost by requiring approval before certain services are provided.
What is prior authorization?