Health Insurance
What is health insurance?
A form of financial protection that eases the financial burden people may experience as a result of illness or injury
What does PMT stand for?
Provider matching tool
What spot do we list to copay?
OV spot on quickview
What is an authorization needed for?
Obtaining approval from the primary care physician as well as health plan (depending on the plan's specifications) prior to receiving health care services, such as visiting specialists, obtaining radiology scans and undergoing surgical procedures.
What does EPO stand for?
Exclusive provider organization
What is a deductible?
A deductible is the amount of money you must pay out-of-pocket for covered expenses before your insurance plan starts paying.
What do we use the PMT for?
To determine if a provider is in or our of network with an insurance
Where should all insurance notes be added?
Name one insurance that requires auth?
VA, Tricare
What does HMO stand for?
Health Maintenance Organization
What is an out-of-pocket maximum?
The absolute most you will have to pay for covered medical services in a single plan year.
Can you filter the PMT?
Yes
Where are authorizations added?
Quickview
Does EAP visits need authorization?
Yes
What is a Medicare Advantage Plan?
These are health plan options approved by Medicare but run by private companies.
A type of cost-sharing in an insurance policy where you pay a fixed percentage of a covered service's cost, while your insurance company pays the remainder.
Name one thing the PMT gives you details about
provider specialty, provider credentials, par insurances, etc
Do we use the amount that populates in Athena?
No- verify in insurance portal.
Who adds an authorization to a patients chart when the pt is coming in for a new pt appt?
BT Team
What is PPO?
Preferred Provider Organization
What is an in network provider?
This refers to doctors, hospitals, pharmacies and other health care providers that have agreed to provide members of a certain insurance plan with services and supplies at a discounted price. Under some insurance plans, your care is covered only if you get it from in-network providers.
What is the PLE used for?
Determine which packages or types of that insurance the provider/facility will accept
Where can we find a patients authorization for services at?
Patient's chart
What all is needed for an auth to be added to a patient's Quickview?
an issue date, expiration date, number of visits, possible dx code, auth #
What are some examples of Medicare Supplemental policies?
Aetna Supp, Mutual of Omaha, AARP