Chapter 48
Coinsurance
A percentage of the allowed charge for health service wich the patient is responsible for paying
Referral
The directing of a patient to a specialist physician by pcp
CHAMPVA
A government health Insurance program that covers dependents of military veterans with service connected disabilities
Coordination of benefits
Rules followed by the insurance companies so that no claim is reimbursed at more than a 100%of the charges
Benefits
Payment for a covered service under a health ins plan
W/C
An insurance program that covers lost wages and health care cost of injured on the job or having wirk related illnesses
Medicaid
The government insurance program for low income individuals and families that is funded both by federal government and by each individual state
Medicare
Federal health Insurance program that provides ins coverage for elderly permanet disable or stage kidney disease
premium
Amount of money paid in a given period to purchase health insurance
Copayment
A fix amount of money that the patient must pay for any health care services
Capitation
A method of paying for insurance in which a fix amount is paid to the provider per member for a specific time period regardless the amount of care provided
Deductible
Amount of money that an insured person most pay annually before health services are covered by the insurance plan
Group plan
One insurance policy that covers a group of people
Verify eligibility status
Determine if the patient has health insurance coverage and will be able to receive health insurance benefits
Verify insurance benefits
Dose the patient insurance cover the proposed service
Tricare
Government Insurance plan that provides medical care to spouses and dependents of an active duty in the military
Birthday rule
If both parents of a child have a health plan the insurance plan whose bday comes earlier in the year is defined as the primary insurance covering the child
Fee for service ins
Insurance reimbursement that is directlly related to the service provided and the amount charge
Assignment of benefits
Insurances reimbursement to be made to the provider of a health service rather than the insured individual
Primary care provider
The heath care practitioner chosen by a patient to provide general medical and also determine and authorize additional medical service that patient might require
