Many people receive ‘benefits’ to pay for healthcare from
their employer or from government agencies. This benefit is called insurance.
The company that administers this benefit is called the insurance carrier or
just the carrier. There are many carriers but just to give an idea I will name
a few of the most popular commercial carriers: Aetna, Blue Cross/Blue Shield, Oxford , Cigna, and United Healthcare.
I referred to these as “commercial” carriers because they
are businesses, corporate entities as opposed to government funded agencies.
There are also government funded insurance plans such as Medicare, Medicaid and
Tricare/Champus. Medicare is a healthcare benefit mostly for people who are
over 65 and/or eligible for social security. Medicaid is coverage for the poor.
These two insurances are governed by a federal agency called The Centers for Medicare
and Medicaid Services [CMS] (www.cms.gov).
Tricare/Champus is coverage for those in military service (www.tricare.mil).
When a patient is treated by a doctor, the doctor sends a
request for payment (a medical claim) to the insurance company. Here’s the
catch, receiving the payment depends on a lot of factors, such are the
patient’s participation status and coverage level with the insurance as well as
the physician’s participation status. Other factors involve whether the claim has
correct and/or sufficient information contained within.
An excellent post! Thank you for all of the detail on the Insurance awareness.
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- New york insurance