Dictionary of Health Insurance and Managed Care

Price: $65.00
(as of Nov 24,2024 14:23:25 UTC – Details)

ASIN ‏ : ‎ 0826149944
Publisher ‏ : ‎ Springer Publishing Company; 1st edition (March 22, 2006)
Language ‏ : ‎ English
Paperback ‏ : ‎ 372 pages
ISBN-10 ‏ : ‎ 9780826149947
ISBN-13 ‏ : ‎ 978-0826149947
Item Weight ‏ : ‎ 2.31 pounds
Dimensions ‏ : ‎ 4.75 x 0.84 x 7.25 inches

Health insurance and managed care can be complex and confusing topics, but having a good understanding of the terms and concepts involved can help you make informed decisions about your healthcare coverage. To help you navigate the world of health insurance and managed care, here is a dictionary of key terms:

1. Premium: The amount of money you pay for your health insurance coverage, usually on a monthly basis.

2. Deductible: The amount of money you have to pay out of pocket for healthcare services before your insurance coverage kicks in.

3. Copayment: A fixed amount of money you pay for a covered healthcare service, such as a doctor’s visit or prescription medication.

4. Coinsurance: The percentage of the cost of a covered healthcare service that you are responsible for paying, after you have met your deductible.

5. Network: The group of healthcare providers, hospitals, and facilities that have contracted with your insurance company to provide care at a discounted rate.

6. HMO (Health Maintenance Organization): A type of managed care plan that requires you to choose a primary care physician and get referrals from them to see specialists.

7. PPO (Preferred Provider Organization): A type of managed care plan that allows you to see any healthcare provider, but you will pay less if you choose one within the plan’s network.

8. EPO (Exclusive Provider Organization): A type of managed care plan that only covers care from providers within the plan’s network, except in cases of emergency.

9. POS (Point of Service): A type of managed care plan that combines elements of HMO and PPO plans, allowing you to see providers both in and out of the plan’s network.

10. Utilization review: The process used by insurance companies to evaluate the medical necessity and appropriateness of healthcare services.

Understanding these key terms can help you navigate the world of health insurance and managed care with confidence and make informed decisions about your healthcare coverage.
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