Studied by 71 people
Co-insurance
the part of the medical costs a patient may still have to pay once the insurance plan’s deductible has been met
Co-pay
a flat fee that many health insurance plans require patients to pay each time they receive health service
Deductible
the money a person must pay before an insurance policy provides benefits
Diagnosed related groups
a classification system used by Medicare and Medicaid to determine payment for health services based on diagnosis, surgical processing, age, and other information
Direct payment
the act of paying for health care with one’s own money
Flexible spending account
A monetary account, offered through an employer, into which money is put through payroll deductions before it is taxed. Funds can be withdrawn for qualified medical expenses as needed, but the funds must be spent each year.
Gatekeeper
a physician who not only delivers primary care services but also makes referrals for specialty care
Government institution
a public health care facility that receives most of its funding from local, state, or federal sources
Government plan
a health care plan funded by a government agency. Government plans are available for active military personnel and their dependents and for veterans. Medicaid and Medicare are also government-funded healthcare programs
Healthcare cost containment
measures designed to lower healthcare costs that aim to create an affordable healthcare system for all Americans
Health maintenance organization plan
a health insurance plan that provides coverage only if the care is delivered by a member of the plan’s hospital, physician, or pharmacy panel
Health savings account
a monetary account commonly paired with a high deductible health insurance plan that allows individuals to pay for qualified medical care using tax-free HSA dollars until they meet their deductibles. Any funds remaining in an HSA at the end of teach year are rolled over and can be saved for future use.
In-network provider
a health care provider who has contracted with the managed care insurance plan
Managed care
a type of health insurance plan that establishes predetermined rates for services with health care providers such as doctors and hospitals, and puts providors in the position of managing patients’ use of healthcare
Medicaid
a government program that offers health insurance to many low-income and disabled people
Medicare
the federally-funded health care program for older Americans
Out-of-network provider
a health care provider who is not in a particular managed care health insurance plan
Point-of-service plan
a physician-coordinated health insurance plan that combines the characteristics of both HMO and PPO plans
Preferred provider organization plan
a health insurance plan that allows patients to receive care
from a non-plan provider, but requires them to pay a higher out-of-pocket price if they do
Premium
The monthly amount paid to an insurance company for health insurance coverage
Private insurance
primarily an employment-based insurance system in the US
Propriety institution
for-profit healthcare facility, usually owned by a corporation
Prospective payment system
a system that pays the provider a fixed amount that’s based on the medical diagnosis or a specific procedure, rather than on the actual cost of hospitalization or care
Resource utilization
all healthcare workers need to ask themselves how they can best use healthcare resources
TRICARE
system that provides medical coverage for active and retired service personnel and their dependents
Utilization review
a process in which an insurer reviews decisions by physicians and other providers about how much care to provide
Voluntary nonprofit institution
community facility that receives federal, state, and local tax, exemptions in exchange for providing a community benefit (such as services to Medicaid patients and those unable to pay)
Note
Flashcard