Term
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Definition
| a group of physicians, hospitals, and providers that offer price discounts to insurance company clients in exchange for more members |
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Term
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Definition
| T or F: If a patient with an HMO goes out of the network to get medical care, they are responsible for the entire costs |
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Term
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Definition
| one in which a member can choose to stay in network and pay the designated co-payment amount or go out of network and pay a deductible and co-insurance for the services rendered |
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Term
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Definition
| an agreement between two or more parties |
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Term
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Definition
| system in which a physician is prepaid monthly for members enrolled in an HMO with which the physician has contracted |
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Term
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Definition
| T or F: In a capitated system, a physician has to return money if he does not see the patients on his list |
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Term
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Definition
| a monthly check the physician receives from the HMO plan |
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Term
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Definition
| a list of patients enrolled in a particular HMO plan with which the physician is capitated |
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Term
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Definition
| a rate determined by the HMO for reimbursement for medical services when the physician is capitated with that plan |
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Term
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Definition
| a payment system in which the physician is paid a specific amount for each service performed |
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Term
| preferred provider organization |
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Definition
| this type of plan offers discounts to insurance company clients in exchange for more members |
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Term
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Definition
| Another name for Medicare Advantage |
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Term
False
You would bill Medicare Advantage |
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Definition
| T or F: When a patient has Original Medicare and Medicare Advantage, they have two plans. Which one would you bill (whether it is true or false)? |
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Term
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Definition
| the patient's share of the cost of health care services |
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Term
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Definition
Which would the patient pay out of pocket?
a) co-payment
b) co-insurance
c) deductible
d) all of the above |
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Term
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Definition
| a health insurance plan in which the patient pays a co-payment when staying in network |
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Term
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Definition
| a plan offered by managed care companies to replace Original Medicare as the patient's health insurance |
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Term
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Definition
| permission from the primary care physician to seek services from a specialist for an evaluation, testing, and/or treatment |
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Term
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Definition
| What types of plans require a referral for a patient to seek services from a specialist? |
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Term
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Definition
| Who gives the referral in managed care plans? |
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Term
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Definition
| the only Tricare plan offering coverage for active-duty service members |
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Term
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Definition
| T or F: Retired military members can select Tricare Prime |
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Term
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Definition
| name of health insurance provided for retired military personnel, active military personnel, and their dependents |
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Term
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Definition
| T or F: Active duty service members are not required to pay an enrollment fee with Tricare Prime |
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Term
| military treatment facility |
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Definition
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Term
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Definition
| a place where Tricare members receive medical treatment |
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Term
| Preferred Provider network |
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Definition
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Term
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Definition
| a group of civilian medical providers that has contracted with Tricare |
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Term
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Definition
| a Tricare plan available only to retired military service members and their families |
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Term
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Definition
| T or F: Tricare Standard is only available to military service members in the United States and not overseas |
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