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Ch. 12 Reimbursement
Commercial Insurance
Question | Answer |
---|---|
Covers the medical expenses of individuals (e.g., private health insurance) and groups (e.g., employer group health insurance. | Commercial health insurance |
Individual health insurance policies are regulated by individual states and include the following: | Fee-for-service High-risk pools Managed care Association health insurance |
Group health insurance is available through employers and other organizations, and all or party of the premium costs are paid by whom? | Employers |
Disability insurance generally does not pay for healthcare services, but provides the disabled person with financial assistance. | True |
What is the role of a medical adjuster? | Reviews healthcare bills submitted to the insurance company for treatment of injuries sustained as the result of a motor vehicle accident to determine coverage. |
Reimbursement for income lost as a result of temporary or permanent illness or injury. | Disability insurance |
When patient are treated for disability diagnoses and other medical problems, separate patient records must be maintained. | True |
How is a disability claim calculated? | Using base pay that usually covers 12 months and is divided into 4 consecutive quarters. |
A policy that covers losses to a third party caused by the insured, by an object owned by the insured, or on premises owned by the insured. | Liability insurance |
Remuneration | compensation for pain and suffering |
What form is used to file a claim with a liability payer? | A regular patient billing statement |
Refers to the contractural right of a third-party payer to recover healthcare expenses from a liable party. | Subrogation |
What does automobile insurance coverage include? | Medical payments Personal Injury Protection |