Chapter 48

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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


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