→ Chapter 3 → A tanulás megkezdése / Letöltés MP3 Flashcards

kérdés		válasz
staff model HMO kezdjen tanulni		Physicians are employees of the HMO and paid a salary
Network model kezdjen tanulni		the HMO contracts with at least two groups medical practices described as in network 2
independent practice Association kezdjen tanulni		Marcus the health plan Physicians contract with the IPA to treat members of HMO
preferred provider organization PPO kezdjen tanulni		a delivery Network that manages and negotiate contracts on behalf of the providers
Health maintenance organizations HMO kezdjen tanulni		prepaid health plan
actuary kezdjen tanulni		a professional who calculates insurance and annuity risks premiums and dividends
exclusive provider organizations EPO kezdjen tanulni		delivery Network inwhich patients must use the services of those provided
copay kezdjen tanulni		the out-of-pocket expense you pay the doctor
deductible kezdjen tanulni		the amount of money the insurer paid before the insurance company will pay
subscriber kezdjen tanulni		Blue Cross Blue Shield known as subscribers rather than policyholders
premium kezdjen tanulni		the price paid by the insured for insurance coverage
capitation kezdjen tanulni		payment method under which each patient is entitled to receive a set dollar amount of services in each time period
Usual fee kezdjen tanulni		determined by whether a provider normally charges for that service
customary fee kezdjen tanulni		based on fee charged buy similar providers within geographic area
reasonable fee kezdjen tanulni		any special circumstance of this accident
cobra. consolidated Omnibus budget reconciliation Act kezdjen tanulni		provides that the employee may continue to be insured through employer plan even after being fired. employee picks up total cost
ERISA. Employee Retirement income Security Act kezdjen tanulni		Federal legislation the mandates how employer funded benefit plans must be in administered
coordination of benefits kezdjen tanulni		if a service is covered under more than one policy then the insurance companies determine who pays
third-party payer kezdjen tanulni		insurance company, government, and Managed Care Organization
Prepaid Plan kezdjen tanulni		all types of health plans in which fixed payments are made before services are rendered
pre-authorization kezdjen tanulni		Insurance requires that certain procedures be authorized by the insurer before they are performed. failure will result in denial of claim
gatekeeping kezdjen tanulni		process of restricting access to services
what is the uninsured statistic kezdjen tanulni		45.7 million people or 17% without insurance
Indemnity insurance kezdjen tanulni		one-party is exempt from incurred liabilities by the other party
self-insured kezdjen tanulni		employer pays for Employees Healthcare
third-party admin kezdjen tanulni		companies that manages the paperwork for an employer who establishes a self insured plan
Managed Care kezdjen tanulni		describes the combination of payment for Healthcare and delivery of services into one system
what did Blue Cross Blue Shield originally cover kezdjen tanulni		they prepaid Baylor University 2 hospitalized for 21 days. a group of teachers
what does a self-insuring employer do kezdjen tanulni		the employer pays for Employees Healthcare
what percentage of Americans are covered by some type of insurance kezdjen tanulni		78%

Chapter 3

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