Definitions of Insurances
What type of insurance is a managed care health insurance plan that provides comprehensive medical coverage through a network of providers?
HMO - Health Maintenance Organization
What "part" covers provider services/office visits?
Part B
This is the only state that offers Medi-cal.
What is 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?
What 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?
PPO - Preferred Provider Organization
Both PPOs and EPOs do not require this to see a specialist.
What is a referral?
The assigned medical group.
What is the most important thing that we look for in HMO's when scheduling?
What 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?
Medi-Cal (Medicaid)
If we schedule a patient as self-pay with a Medi-cal health plan it can jeopardize for this to happen.
What is termination of policy?
This hybring 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?
What 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?
Medicare A & B
This type of plan offers the most flexibility in choosing providers but at a higher cost
What is a PPO?
HMOs often use this method to control cost by requiring approval before certain services are provided.
What is prior authorization?