A predetermined amount a Member must pay each calendar year before the Plan will pay for any covered treatments and services.
What is a Deductible?
Pain in the chest related to the heart that comes and goes.
What is Angina?
Medicare was first enacted as part of Social Security Act, signed by Lyndon Johnson in this year.
What is 1965?
A request for review, and change, for a coverage decision made by an insurance plan.
What is an Appeal?
What is ANOC (Annual Notice of Change)?
The percentage owed by a Member for services rendered after a deductible has been met and a co-payment has been paid.
What is Co-insurance?
A tissue sample for testing purposes.
What is Biopsy?
Medicare was expanded to include individuals under the age of 65 with long-term disabilities and individuals with ESRD.
What is 1972?
Any complaint, or dispute (other than a determination), expressing dissatisfaction with a Medicare health plan.
What is a Grievance?
Form giving an individual the ability to speak on grievances, determinations, and appeals on a member's behalf.
What is AOR (Appointment of Representative)?
A term given to Primary Care Providers because they are responsible for coordinating patient's care to specialists, hospital admissions, etc.
What is Gatekeeper?
Broken bone that shatters into many pieces.
What is Comminuted Fracture?
Bill Clinton signed the Health Insurance Portability Act into law to modernize the flow of healthcare information.
What is 1996?
An approval to see a specialist given by a primary care physician.
What is a Referral?
Traditional identification number for Medicare members.
What is HICN (Health Insurance Claim Number)?
The contract, or agreement, that outlines the terms of insurance coverage.
What is a Policy?
Disease is not getting worse; not to be confused with being cured.
What is In Remission?
Barrack Obama enacted the Patient Protection and Affordable Care Act reform to decrease the number of uninsured Americans.
What is 2010?
Approval from a plan to cover a service, drug, or treatment that is deemed medically necessary.
What is a Prior Authorization?
An organization that coordinates cost effective delivery of health services.
What is MCO (Managed Care Organization)?
A health care provider is paid a fixed amount per member, per month, for each patient who is a member of a particular insurance organization, regardless of whether services were provided.
What is Capitation?
Most common type of white blood cell.
What is a Neutrophil?
Medicare Catastrophic Coverage Act enacted to change Medicare which includes;
*Improved hospital / skilled nursing facility benefits
*Covered mammography
*Included outpatient prescription drug benefit
*Cap on patient liability
What is 1988?
A decision whether or not an insurance plan will cover a service, drug, or treatment.
What is a Determination?
Information tied to an individual protected by HIPAA.
What is PHI (Personal Health Information)?