Insurance Basics
All insurance is based on this.
What is risk?
The amount that must be paid out of pocket by the policyholder before an insurance provider will pay any expenses.
What is a deductible?
Another name for an insurance company.
What is a third-party payor?
Government insurance program for adults over 65.
What is Medicare?
A group of physicians, health care providers, and services of all types that are recognized by an Insurance Company because they agree to its fee structure
What is in-network?
Any amount or costs a patient must pay themselves.
What are out-of-pocket expenses?
Insurance policy that requires you to see your primary care provider and obtain a referral before seeing a specialist.
What is a health maintenance organization (HMO)?
Government insurance program for low-income individuals.
What is Medicaid?
This document looks like a bill but it isn’t. It tells what the insurance company paid and what your expenses will be.
What is an explanation of benefits (EOB)?
A fixed amount you pay for covered services, typically when you get the service.
What are copays?
Insurance policy that allows you to see specialists directly without a referral from a family doctor. The specialist must be “in-network”.
What is a PPO or preferred provider organization?
Government insurance program for children in low-income families.
A savings account for health care expenses.
What is a medical IRA?
The amount of money an individual or business pays for an insurance policy.
A system of health insurance payments in which health professionals are paid fixed amounts per month based on the number of insured people they have as patients.
What is capitation?
Insurance for those serving in the military and their families.
What is TRICARE?
Numbers and letters used to classify illnesses, injuries, and conditions. They are used universally throughout the world.
What are ICD-10 codes?
An insurance policy provision that eliminates coverage for expenses incurred due to a specific event or illness.
What are exclusions?
The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service.
What is UCR or Usual, Customary and Reasonable?
Medicare is run by the
A) Federal government
B) State government
C) Both
What is "A) Federal government"?