The method by which you choose a physician if you have a PPO insurance policy
What is choose from the preferred provider list
100
This is what the acronym HMO actually stands for
What is a Health Maintenance Organization
100
Another name for this type of policy
What is fee for service
100
A direct care primary medical home is technically not considered this
What is health insurance
100
Define the term premium as it relates to insurance
What is the amount you pay for coverage (your bill)
200
The amount you must pay toward each visit or procedure
What is a co-pay
200
From a patient perspective, describe one advantage of an HMO
Lower premiums and co-pays
200
Describe one advantage of an indemnity insurance policy
What is flexibility in choosing providers
200
With a DCPMH you would still need this type of health insurance to cover costs.
What is a catastrophic care policy
200
This type of health insurance is government funded and provides assistance to the elderly
What is Medicare
300
This happens when you decide to see a provider not on the company provider list
What is pay a greater percentage of the cost
300
The early HMO plans became controversial by providing this to physicians
What is bonus check for keeping costs low
300
Describe one disadvantage of an indemnity policy
What is it is generally more expensive
300
Who receives the monthly premium from a DPCMH?
What is the healthcare provider
300
This type of insurance is government funded and provides care for the economically disadvantaged.
What is Medicaid
400
In order to be on the preferred provider list, a healthcare provider must do this
What is contract with the insurance company for the reimbursement amount
400
With an HMO plan, you are usually required to obtain this before visiting a specialist
What is a referral from your PCP and sometimes the insurance company
400
This is generally not required for a standard indemnity policy
What is pre-approval or referral
400
What is one disadvantage of a DCPMH
What is no coverage for catastrophic illnesses
400
What is the major provision of the healthcare reform bill that is being debated by the Supreme Court
What is government mandate that all must purchase insurance
500
This is the only exception to the required pre-approval for treatment by a specialist
What is an emergency situation
500
Compare payment of physicians with an indemnity policy to that of a PPO policy
What is a PPO will make a contract with the physician for the costs of procedures. An indemnity policy will pay whatever cost set by the physician
500
Describe how utilizing a DCPMH has been compared to car insurance.
Just as you use car insurance for major events only, if you have a DCPMH you would use your insurance for major events only and your DCPMH for minor medical expenses.
500
Explain why insurance groups with more members can have lower premiums than insurance groups with few members
What is the cost for catastrophic illness is spread over a greater number of individuals