What Types of Insurance Plans Are There?
Managed Care
Fee-for-Service Plans (Traditional Indemnity )
Health Maintenance Organization (HMO)
Point-of-Service Plan(POS)
Preferred Provider Organization (PPO)
Types of Health Insurance
The two main ways that people obtain health coverage are by paying into a group or buying individual insurance.
Ø Group Health Plans
Ø Individual Insurance Plans
Group Insurance Plans
Most Americans get health insurance through their jobs or are covered because a family member has insurance at work. This is called group insurance. Group insurance is generally the least expensive kind. In many cases, the employer pays part or all of the cost.
Some employers offer only one health insurance plan. Some offer a choice of plans: a fee-for-service plan, a Health Maintenance Organization (HMO), or a Preferred Provider Organization (PPO), for example. Employers with 25 or more workers are required by Federal law to offer employees the chance to enroll in an HMO.
What happens if an individual or his family member leaves the job? He will lose employer-supported group coverage. It may be possible to keep the same policy, but he will have to pay for it himself. This will certainly cost him more than group coverage for the same, or less, protection. A Federal law makes it possible for most people to continue their group health coverage for a period of time called COBRA (for the Consolidated Omnibus Budget Reconciliation Act of 1985), the law requires that if an individual work’s for a business of 20 or more employees and leave the job or are laid off, he can continue to get health coverage for at least 18 months. He will be charged a higher premium than when he was working.
He / she also will be eligible to get insurance under COBRA if their spouse was covered but now he /she is widowed or divorced. If an individual was covered under his parents group plan while he was in school, he can also continue in the plan for up to 18 months under COBRA until the individual find a job that offers individual health insurance.
Not all employers offer health insurance. Individual might find this to be the case with his job, especially if he work’s for a small business or work part-time. If the employer does not offer health insurance, he might be able to get group insurance through membership in a labor union, professional association, club, or other organization.
Individual Insurance Plans
If the employer does not offer group insurance, or if the insurance offered is very limited, one can buy an individual policy. One can get fee-for-service, HMO, or PPO protection.But an individual should compare the options and shop carefully because coverage and costs vary from company to company. Individual plans may not offer benefits as broad as those in group plans
Ø Group Health Plans
Ø Individual Insurance Plans
Group Insurance Plans
Most Americans get health insurance through their jobs or are covered because a family member has insurance at work. This is called group insurance. Group insurance is generally the least expensive kind. In many cases, the employer pays part or all of the cost.
Some employers offer only one health insurance plan. Some offer a choice of plans: a fee-for-service plan, a Health Maintenance Organization (HMO), or a Preferred Provider Organization (PPO), for example. Employers with 25 or more workers are required by Federal law to offer employees the chance to enroll in an HMO.
What happens if an individual or his family member leaves the job? He will lose employer-supported group coverage. It may be possible to keep the same policy, but he will have to pay for it himself. This will certainly cost him more than group coverage for the same, or less, protection. A Federal law makes it possible for most people to continue their group health coverage for a period of time called COBRA (for the Consolidated Omnibus Budget Reconciliation Act of 1985), the law requires that if an individual work’s for a business of 20 or more employees and leave the job or are laid off, he can continue to get health coverage for at least 18 months. He will be charged a higher premium than when he was working.
He / she also will be eligible to get insurance under COBRA if their spouse was covered but now he /she is widowed or divorced. If an individual was covered under his parents group plan while he was in school, he can also continue in the plan for up to 18 months under COBRA until the individual find a job that offers individual health insurance.
Not all employers offer health insurance. Individual might find this to be the case with his job, especially if he work’s for a small business or work part-time. If the employer does not offer health insurance, he might be able to get group insurance through membership in a labor union, professional association, club, or other organization.
Individual Insurance Plans
If the employer does not offer group insurance, or if the insurance offered is very limited, one can buy an individual policy. One can get fee-for-service, HMO, or PPO protection.But an individual should compare the options and shop carefully because coverage and costs vary from company to company. Individual plans may not offer benefits as broad as those in group plans
Why you Need Health Insurance?
The United States does not have socialized medical care. If a person does not have health insurance coverage, he / she have to pay for health care out of their own finances at the time of service. This can run into many thousands of dollars for serious illnesses
One buy’s health insurance for the same reason one buy’s other kinds of insurance, to protect one self financially. With health insurance, an individual and their family are protected in case of any medical care that could be very expensive.
One cannot predict what his medical bills would be. In a good year, costs may be low but if he becomes ill, medical bills could be very high. If he has insurance, many of medical costs are covered by a third-party payer, not by the individual. A third-party payer can be an insurance company or, in some cases, it can be the employer.
Many people in the United States are enrolled in some sort of managed care plan. This is an organized way of both providing services and paying for them. Different types of managed care plans work differently and include preferred provider organizations (PPOs), health maintenance organizations (HMOs), point-of-service (POS) plans and fee-for-service plans.
Individuals enrolled in health care plans pay a monthly or quarterly fee as insurance for the time when they will need medical attention. At the time when a service is provided, the health insurance organization pays part or the entire fee, minimizing the amount an individual have to pay at the time of service.
Choosing the right insurance plan that best meets financial circumstances will depend on information like, whether an individual is married or single, have children or no children. Definitions of the health insurance terms used are included in the section called Understanding Health Insurance Terms.
One buy’s health insurance for the same reason one buy’s other kinds of insurance, to protect one self financially. With health insurance, an individual and their family are protected in case of any medical care that could be very expensive.
One cannot predict what his medical bills would be. In a good year, costs may be low but if he becomes ill, medical bills could be very high. If he has insurance, many of medical costs are covered by a third-party payer, not by the individual. A third-party payer can be an insurance company or, in some cases, it can be the employer.
Many people in the United States are enrolled in some sort of managed care plan. This is an organized way of both providing services and paying for them. Different types of managed care plans work differently and include preferred provider organizations (PPOs), health maintenance organizations (HMOs), point-of-service (POS) plans and fee-for-service plans.
Individuals enrolled in health care plans pay a monthly or quarterly fee as insurance for the time when they will need medical attention. At the time when a service is provided, the health insurance organization pays part or the entire fee, minimizing the amount an individual have to pay at the time of service.
Choosing the right insurance plan that best meets financial circumstances will depend on information like, whether an individual is married or single, have children or no children. Definitions of the health insurance terms used are included in the section called Understanding Health Insurance Terms.
Medical Emergency
In an emergency, the first thing to remember is "911". This is the telephone number to call from anywhere in the United States for immediate, skilled medical attention. While it is wise to have other important numbers regarding medical assistance (individual’s personal doctor, poison control center, etc.) near telephone, in a genuine emergency it is imperative to dial 911 first. In such situations, time is the most important factor in preventing damage or even loss of life. The operator handling your "911" call will immediately dispense the necessary help, both in terms of sending an ambulance and in routing individual’s call to a counselor who will guide through the situation until the ambulance arrives.
Emergency medicine in the U.S. is very high quality. Ambulance attendants, or paramedics, are highly trained in dealing with trauma and making split-second decisions that save lives.
And many hospitals are equipped with trauma centers whose single purpose is handling emergency situations, including emergency surgery. In an emergency, individual will begin to receive treatment immediately and will be taken to the facility that can best handle the situation, whether it is a trauma center, a burn treatment center, a cardiac treatment center (heart attacks), a children's hospital or a general hospital. If an individual is conscious, or if there is a family member or a friend with the individual, they will be asked for the name of patient’s doctor, who will be summoned to the hospital to which patient is taken.
It is important to keep in mind that while emergency care in the U.S. is excellent, it is also expensive. There will be a fee for the ambulance, the emergency room, any medications administered, the services of doctors involved and any tests or special procedures involved. It is important never to hesitate when there is a genuine emergency but these services are not intended for situations where a call to your doctor or a visit to a walk-in clinic would be sufficient.
An additional note about "911": This number is also used in police emergencies, and therefore is not limited to medical situations. Any time an individual is in serious danger, witness an accident or a crime in progress, this number is called.
Health Care In U.S.
Medical care in the United States is generally very high quality. The government closely monitors medically oriented businesses and institutions. Hospitals, clinics, medical schools, and pharmaceutical companies must comply with government standards. Doctors, nurses and other medical personnel must be licensed, and becoming a medical specialist frequently entails fifteen years or more of rigorous schooling and training. The high level of technology available in the U.S. contributes to quality care, and the average hospital contains millions of dollars worth of state-of-the-art equipment.
Medical and health care is big business. Hospitals and medical schools also spend substantial amounts on research, knowing that new techniques and discoveries will bring them prestige, patients, and money, while benefiting many people. The result for consumers is ever improving quality and effectiveness of medical care, but at the same time expensive care.
When seeking any kind of medical assistance in the United States, there are few free services, and most care is expensive. Unlike other countries, there is little government sponsored health care here, except for those over 65 years of age (Medicare), or for the poor (Medicaid). The insurance industry is a major influence in the business of staying well or regaining one's good health. Obtaining some type of health insurance coverage to protect one self and their family is very smart, but expect it to be a significant monthly expense.
Medical and health care is big business. Hospitals and medical schools also spend substantial amounts on research, knowing that new techniques and discoveries will bring them prestige, patients, and money, while benefiting many people. The result for consumers is ever improving quality and effectiveness of medical care, but at the same time expensive care.
When seeking any kind of medical assistance in the United States, there are few free services, and most care is expensive. Unlike other countries, there is little government sponsored health care here, except for those over 65 years of age (Medicare), or for the poor (Medicaid). The insurance industry is a major influence in the business of staying well or regaining one's good health. Obtaining some type of health insurance coverage to protect one self and their family is very smart, but expect it to be a significant monthly expense.
What Is Medical Billing?
Medical billing is better described as full medical practice management and a doctor's key to getting paid. Full medical practice management," meaning that billing office handle all the bookkeeping and accounting functions for their doctor-clients, including patient statements, recording payments, preparing financial reports, and even consulting the physicians on issues such as how to negotiate contracts with the growing number of managed care companies such as HMOs and PPOs that are trying to reign in doctors' fees.
Medical billing involves preparation of medical bills on behalf of the doctor for the treatments performed on the patients. The work also involves sending the medical bills to the respective insurance company with whom the patient is a beneficiary. The billing department also collects the money from the insurance company on behalf of the doctors. The insurance company pays for the treatments billed by the billing office.
The Medical Billing industry is a subsidiary of the Health care industry. Medical Billing is the financial-data management of a physician or a group of physicians’ practices. This means maintaining all of the physician’s non-medical records and keeping track of and collecting all money due to him.
Medical billing involves preparation of medical bills on behalf of the doctor for the treatments performed on the patients. The work also involves sending the medical bills to the respective insurance company with whom the patient is a beneficiary. The billing department also collects the money from the insurance company on behalf of the doctors. The insurance company pays for the treatments billed by the billing office.
The Medical Billing industry is a subsidiary of the Health care industry. Medical Billing is the financial-data management of a physician or a group of physicians’ practices. This means maintaining all of the physician’s non-medical records and keeping track of and collecting all money due to him.
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