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Week 1 Vines Ch. 1, 2
Terms in this set (20)
A provider who signs a contract with an insurance carrier to see patient's at a discounted rate. PARs are usually listed in a provider book given to beneficiaries at enrollment.
Non- Participating Provider
A provider who does not have a contract with a designated insurance carrier and is not obligated to offer discounted rates.
An organization of members contracted with a managed care organization.
Schedule of Benefits
A list of medical services covered under an insurance policy and the amount paid for each treatment.
A diagnosis or condition for which a beneficiary is treated prior to the effective date of coverage with his or her insurance carrier.
The transfer of total care or a specific portion of care of a patient from one physician to another.
Primary Care Physician
A provider who coordinates a patient's care.
A patient who has been admitted to the hospital and expected to stay 24 hours or more.
Amount a beneficiary is responsible for before the insurance company pays as stated in the insurance policy.
A patient who is treated at a hospital or other medical facility during a stay less that 24 hours.
An individual who takes out an insurance policy in his or ner name.
A fixed dollar amount the patient pays at each visit or hospital encounter, as specified in the patients insurance policy.
Parties responsible for issuing insurance policies.
Percentage of the allowed amount that is the patient's responsibility.
Assignment of Benefits
Request made by a patient to allow the insurance carrier to pay the healthcare professional directly rather than issuing monies to the patient.
Owner of an insurance policy.
Authorizations from an insurance company that allow a patient to receive treatment using their benefits. Some insurance companies require this prior to admission for hospital stay or outpatient surgery.
An individual listed as the policy holder under an insurance agreement.
Dollar amounts a person pays for an insurance policy. Often deducted from an employees paycheck.
Persons responsible for payment of insurance premiums or persons whose employment or group affiliation is the basis for membership in a health plan.
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