Unit 2: Legal and Administrative Issues in Sports Medicine

General Health Insurance

- covers illness, hospitalization, and emergency care. Sometimes offered through schools for students (athletics). Schools and universities must ensure that individuals have primary insurance coverage. Secondary institutions provided thru institutions to cover coasts above primary insurance coverage.

Professional Liability Insurance

Insurance that protects directors, officers, employees, and organizations against claims of negligence in the performance of professional services.

HMO

health maintenance organization

health maintenance organization

It is the cheapest and least flexible. HMO will pay 100% of costs if care rendered within the HMO plan providers. ATs must have working knowledge of HMO limits and restrictions.

Secondary Insurance

the health plan that pays benefits after the primary plan when a patient is covered by more than one plan

Primary Insurance

The health plan that pays benefits first when a patient is covered by more than one plan.

PPO

preferred provider organization

Preferred Providers Organization

Provide discount healthcare and also limit where treatment can be obtained. Pay by a fee for service basis. May included additional types of coverage.

POS

point of service

point of service

Combo of HMO & PPO. Based on HMO model but allows for care outside of plan. Flexibility is allowed for certain conditions.

Medicare

Federal insurance for the age and disabled. A- hospital portion- premium free at retirement to beneficiaries. B- physical portion- monthly premium charge.

Medicaid

For people with low income and limited resources. Funded by federal government and states. Benefits vary to state.

workers composition

Laws and benefits for injured workers are mandated by states. Employer pays premiums and claims are settled by workers, compensation insurance carriers.

Physician Hospital Organization (PHO)

Involves a major hospital or hospital chain and its physicians. PHO organization contract directly with employers to provide services and/or contracts with managed care organizations.

ICD-10 (billing codes)

International classification of diseases that is used for specifics a particular condition being treated.

CPT billing codes

Current procedural terminology code that is used for specifics a particular procedure for treatment.

NPI number

Government issued identification number for individual healthcare provides and organizations.