1.4 Health Insurance Terms

What is the fixed amount payment made by the patient in addition to the payment from the insurer?

Co-pay
Deductible
Premium
Co-insurance

If a service is listed as a covered benefit by the insurer, but additional documentation and forms are required for approval/coverage, this process is called ______.

preauthorization
in-network
out-of-network
medical necessity

What is one consideration when working with a patient with visit limitations?

Are visits based on discipline or all therapies combined
Use all of the visits the patient has to maximize their insurance coverage
Encourage the patient to skip therapy outside of the clinic setting to save visits
None – you can always ask for more visits

What is a co-insurance?

A fixed amount the patient pays for a covered service after meeting their deductible
A percentage of the cost the patient pays after they have met their deductible
The amount a patient pays before insurance coverage starts
A fee that only applies to out-of-network services

Why is it important to explain visit limitations to patients?

To encourage them to use all their visits as quickly as possible
To minimize the number of therapy sessions required
To involve them in planning their therapy strategy and optimize visit usage
To avoid discussing insurance coverage with patients to prevent confusion

Module 1: Navigating US Healthcare System

01/13/2023

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