Learning Health Insurance for Medical Billing

HMO- (Health Maintenance Organization)- most non emergency treatment needs PCP, normally requires referrals to go to different specialties.

PPO- Preferred Provider Organization- a selected network of providers. Usually no referrals required. Usually have copays.

POS- Point of Service- a hmo plan with option to opt out of network without a referral for a higher fee.

Indemnity Insurance- covers large amount of network providers. Pt Usually have a 20% coinsurance.

Government Programs-(to help assist the elderly, disabled and low income)
Medicaid- funded by the state. No fees to the patient
Medicaid Family Planning Only(visits related to contraceptive management)
MCO-Medicaid HMO or Managed Care Organization
CHIP (Children Health Insurance Program) no premium, no copays for pregnant women
and children.
CHIP premium- Low cost monthly premium to parents with higher incomes
Medicare- Normally for patients over 65, or young patients with disabilities or people
with End Stage Renal Disease.