Chapter 2 Flashcards
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| 7522440761 | Insurance -health insurance offsets the costs of illness and/or injury -escalating medical costs have limited insurance coverage options - Patients may have more than one insurance costs | One of the world's largest business | 0 | |
| 7522498189 | -Patient Protection and affordable Care Act (PPACA) -As of June 28, 2012, the Supreme Court upheld the PPACA in its entirety -Health Care and Education Reconciliation Act (HCERA) of 2010 | Major restructuring of the U.S. health care system was necessary during the 1990s | 1 | |
| 7522563226 | $325 per individual or 2% of taxable income | What was the fine per individual without health insurance in 2015 | 2 | |
| 7522619957 | -Clearinghouses will allow individuals to compare coverage and prices -Individuals can purchase through clearinghouses to take advantage of federal subsidies | State-based American Health Benefit Exchanges and Small Business Health Options (SHOP) | 3 | |
| 7522697845 | 1) The person must be a mentally competent adult and not under the influence of drugs or alcohol 2) The insurance company must make an offer (the signed application) and the person must accept the offer (issuance of the policy) without concealment or misrepresentation of facts on the application 3) An exchange of value | Four considerations in valid insurance contracts: | 4 | |
| 7522742004 | -not manifested by direct words, but implied or deduced from the circumstance, the general language, or the conduct of the patient -Most physican contracts are implied | Implied Contract | 5 | |
| 7522753749 | -Can be a written or verbal contract | Expressed contract | 6 | |
| 7522761759 | You need to be 18-21 | In order to have a contract, | 7 | |
| 7522767822 | No medical insurance. Patient is liable for entire bill | Self Pay Patient | 8 | |
| 7522771699 | Individual who promised to pay the medical bill by signing a form agree to pay or who accepts treatment (expressed promise) | Guarantor | 9 | |
| 7522788831 | Person younger than 18, who lives independently, is totally self supporting, is a parent even if not married, or is in the military and decision-making rights | Emancipated Minor | 10 | |
| 7522800202 | Physician is under contract to see managed care patients. Contract begins when patient is first seen | Managed Care Patients | 11 | |
| 7522817030 | -No physician-patient relationship -Exam only, patient is not seeking medical services | Employment Disability Examinations | 12 | |
| 7522827336 | -Industrial accidents or illnesses -Contract exists between the physician and the insurance company | Worker's Compensation Patients | 13 | |
| 7522854984 | Extended benefits contract to offset large medical expenses caused by proonged illness or serious injury | Major medical | 14 | |
| 7522864244 | Individual or organization protected in case of loss under terms of the insurance policy Also known as: -Superscribe -Member -Policyholder -Recipient | Insured | 15 | |
| 7522918435 | -cancelable -optionally renewable -conditionally renewable -guaranteed renewable -noncanceable policy | Policy Renewal Provisions 5 classifications: | 16 | |
| 7522954941 | Premium | Monthly, quarterly, or annual fee to keep insurance active | 17 | |
| 7522959601 | Deductible | Specific amount of money paid each year before policy benefits begin | 18 | |
| 7522962729 | Coinsurance/Co-payment | Cost sharing requirements in which the insured assumes a percentage of the fee or pays a specific amount for covered services | 19 | |
| 7523000414 | -code diagnoses and services rendered -complete insurance claim -to be continued | Insurance billing specialists abstracts information from the patient record to: | 20 | |
| 7523014724 | Coordination of Benefits -Prevents duplication or over lapping of payments for the same expense | When the patient has more than one insurance policy, this statement requires insurance companies to coordinate the reimbursement of benefits to determine the primary and secondary carriers | 21 | |
| 7523049110 | Exclusion Examples: -Attempted suicide -military service -on the job injuries -fertility coverage -pregnancy -preexisting conditions | Injury or illness that is not covered by the insurance policy | 22 |
