Medical Insurance101
a bill sent to an insurance carrier requesting payment for services rendered
What is a insurance claim
statement is included in most policies and contracts with health care organizations
What is coordination of benefits (COB)
Type of policy has a higher premium and, often, the benefits are less than those obtainable
What is a group health plan
handling and processing insurance claims in a health care organization’s office
What is revenue cycle management
plans are marketed by the private health insurance industry rather than through government-sponsored programs are called
What private health Plans
the contract for treatment is between the health care organization and the patient
What is self pay
known as a subscriber, member, policyholder, or recipient and may not necessarily be the patient seen for the medical service
What is an insured
requires employers with 20 or more workers to extend group health insurance coverage in light of certain events. Coverage is extended to the employee and their dependents at group rates for up to 18 months
What is COBRA
What do some providers do before a new patient comes in for there appointment ?
What is a pre-registration
type of managed care plan that provides coverage of health services for a prepaid, fixed annual fee.
What is an HMO
a person who accepts treatment or signs a form agreeing to pay
What is an guarantor
policy grants the insurer the right to cancel the policy at any time and for any reason.
What is a cancelable policy
is a type of tax-free savings account that allows individuals and their employers to set aside money to pay for health care expenses
medical savings account (MSA)
What must be verify before the patient comes in
What is verification of insurance
the only insurance payer that you have three alpha prefix
What Is BCBS or Anthem
a person younger than 18 years of age who: Lives independently, Is totally self-supporting, Is married or divorced,• Is a parent even if not married,• Is in the military and possesses decision-making rights, or• Is a college student living away from home, even when financially dependent on parents.
What is emancipated minor
is defined as accepted health care services and supplies that are appropriate for the evaluation and treatment of an injury, illness, or disease and its symptoms.
Medically necessary”
Type of managed health care plan in which subscriber members are eligible for benefits only when they use the services of a limited network of health care organizations
What is EPO Exclusive Provider Organization
handling and processing insurance claims in a health care organization’s office
What is Assignment of Benefit
Most managed care plans use a as a gatekeeper
What is a PCP
cases involve a person being injured on the job
What is worker compensation
Insurance companies issued policies that did not provide benefits for conditions that existed and were treated before the policy was issued
what is preexisting conditions
an organization that provides a wide range of comprehensive health care services for a specified group at a fixed periodic payment
What is an HMO
What form has diagnosis and procedures codes and dates of service with the billed amount
Whatis an encounter form or CMS 1500 ,UB-04
Expense to patients in the form of copayments and coinsurance varies from plan to plan
Out-of-pocket expense