Question

1. A patient has asked you to explain her insurance policy to her. Can you discuss the different types of insurance policies?

2, Which insurance benefits are determined by fee schedules or fee-for-service plans? What might be the advantages of this?

3. Mrs. Jones has called for an appointment. She is a new patient. How will you verify her insurance benefits?

Answer 1

1.Insurance policy is a formal contract between an insurer and an insured. Here the policy holder determines the claims which the insurer has to pay.

There are 2 main common types of life insurance policy in healthcare

• Term :It pays only after death
• Whole term:It pays a death benefit at whatever age people die.It fphas three sub types namely traditional whole life,universal life,variable universal life.

In US it has three types of plans namely

• Health maintainance organization : It covers on the basis of monthly or yearly.It has a group of provider in contract and has certain limits in the medical aid provided
• Point of service plans:It is a combination of PPO and POS
• Preferred Provider Organization : Here the patients can select their preferred Provider without even referrals

2)Fee for service plan is a choice for most clients.This plan will either pay the medical provider directly or the patient can reimburse it for the medical expenses incurred

The main advantage of this plan is

• The doctors can be selected on the basis of choices
• Any physicians can be met nationwide
• can actively take part in making decision on the treatment decided by the provider

3)The insurance benefits can be verified by the following ways

• Request for the ID and the original health insurance card
• Confirm the coverage by making a call to the insurance provider or contact online the Medical Insurance Bureau
• Request disclosure of the insurance coverage to know about the benefits available for that insurance policy of the patient.