There are three basic types of medical insurance plans. They
are Managed Care Plans, Indemnity plans and Combination Plans. The three plans are very different in method
and focus, here’s how:
Managed Care Plans
|
Indemnity Plans
|
Combined Plans
|
Focus on
preventative care
|
Focus on present
illness
|
Any combination of
the managed care and Indemnity plans as written by the insurance carrier
|
Strict
authorization/referral guidelines
|
Fewer requirements
for service authorizations. No referrals
|
|
Limited list of
physicians covered in network
|
Larger list of
network physicians. Policies sometimes have out of network benefit coverage
|
|
No deductible
|
Has deductible
|
|
No coinsurance
|
Has co-insurance
|
|
Small out of pocket
costs for the patient in the form of co-payments
|
Larger out of
pocket expense with deductibles and coinsurances. No co-payments
|
|
Summary
|
Summary
|
Summary
|
More rules less
expense
|
More expense less
rules
|
Depends on the plan
and benefits
|
In some situations patient's who have been injured will be covered by a “liability carrier”. This may be the
auto insurance or workman’s compensation carrier.
Liability insurance does not have traditional insurance
card. The information will be provided by the patient initially. The patient should
give you the name and contact number for an insurance representative called the
“adjustor” in addition to their id number called by the liability carrier the
“claim number”. The adjustor reviews the accident details and handles the
medical claim payment. When you speak to the adjustor for the first time to
confirm coverage be sure to obtain the following information:
A.
The “claim number”. This number is in place of a
medical insurance policy number. The liability carrier will refer to the
accident and injury as a “claim”, don’t get confused.
B.
The accident date. This information will be required on
the claim form for an accident.
C.
Documentation requirements. It is a pretty safe bet
that the liability carrier will want documentation or doctor’s notes with every
medical bill.
D.
Their fax number. This will help when you have to send
documentation or forms and sometimes they will allow claim submission via fax
too.
